The Effect Of Single-incision Laparoscopic Distal Gastrectomy On Immune Function Under The Guidance Of The Concept Of Enhanced Recovery After Surgery

Objective:To explore the influence of single-incision laparoscopic radical resection of distal gastric cancer on patients' immune function under the guidance of the concept of Enhanced Recovery After Surgery.Methods:The clinical data of 90 patients diagnosed with early distal gastric cancer and undergoing laparoscopic distal gastrectomy(LDG)in our hospital from January 2014 to December 2016 were retrospectively analyzed.Patients were divided into three groups.Group A,underwent traditional multiport laparoscopic distal gastrectomy with ERAS concept;group B,underwent SILDG with ERAS concept;and group C,underwent traditional multiport laparoscopic distal gastrectomy with conventional perioperative management.The changes of intraoperative,postoperative and immune function indexes of the three groups were compared.Preoperative surgical risk assessment for patients according to the American society of anesthesiology classification(ASA)is as follows: I,healthy patients;?,mild systemic diseases;?,severe systemic disease;?,severe systemic disease,the threat to life;V.Dying patients cannot survive for more than 24 hours without surgery or without surgery.The operation time was calculated from making an incision to stitch incision.Inclusion criteria were: 1.tumor clinical stage was I A or I B according to the seventh edition of American Joint Committee on Cancer(AJCC);2.conventional LDG and SIDG were performed along with D1 or D1+ lymph node dissection;3.all the operations were performed by the same surgeon.Exclusion criteria were: 1.patients had a history of gastric surgery;2.patients with conversion to open surgery;3.patients with body mass index(BMI)>30 kg/m2 or BMI< 15 kg/m2;4.patients were at ASA IV or V stage,according to the American Society of Anesthesiologists classification(ASA).Recording the three groups of patients' clinical data and making a statistical analysis.Using the SPSS 22.0 as statistical method.The normal distribution of the measurement data was expressed by means ± SD,compared using analysis of variance between groups,two comparison using Tukey HSD test.The count data were expressed as frequency and percentage,the chi-square test and Fisher's exact test were used for comparison,and the nonparametric rank sum test was used for rank data.If the P-value was <0.05,it was considered as statistically different.Results:In the comparison of intraoperative indicators among the three groups,compared with group A and group C,the operation time of group B was significantly prolonged(P<0.005),but there was no significant difference in the number of lymph node dissection and intraoperative blood loss among the three groups(P >0.05).In terms of comparison of postoperative indicators,compared with group C,patients in group B had earlier postoperative time to get out of bed,intestinal ventilation recovery,and semi-fluid diet(P<0.05),and the postoperative hospital stay was significantly shortened(P<0.05).However,compared with group A,group B showed no significant difference in postoperative time of getting out of bed,intestinal ventilation recovery and postoperative hospital stay(P>0.05).In terms of changes in immune function indicators,postoperative levels of CD3+,CD4+,CD8+,CD4+/CD8+,and TGF-were significantly higher in group B than in group C(P<0.05),and CD8+,CD4+,and CD4+/CD8+ were significantly lower than in group C(P<0.05),with no significant difference from group A(P>0.05).Conclusion:The application of single-incision laparoscopy in the radical resection of distal gastric cancer under the guidance of ERAS concept can shorten the postoperative hospitalization time,accelerate the recovery of intestinal function,and play an effective role in protecting the immune function.However,compared with traditional multiport laparoscopic distal gastrectomy under the guidance of ERAS,the advantages are not very obvious.