Objective To evaluate the use of fast track surgery （FTS） in the treatment for cholecystolithiasis combined with calculus of common bile duct （CBD） by combination of laparoscope and duodenoscope. Methods One hundred and twenty patients with cholecystolithiasis combined with calculus of CBD underwent laparoscopic cholecyst-ectomy （LC） and endoscopic retrograde cholangiopancreatography （ERCP） were divided into FTS group （n=55） and conventional group （n=65），which were accepted the perioperative therapy of FTS or conventional therapy，respectively. After operation，the incision pain，nausea and vomiting，infusion time，loss of body weight，out-of-bed time，dieting time，postoperative hospitalization，hospital costs，and complications were compared in two groups. Results Compared with the conventional group，the postoperative infusion time，dieting time，out-of-bed time，and postoperative hospitali-zation were shorter，the incidence rates of pulmonary infection，and urinary systems infection，pancreatitis，nausea and vomiting， and incision pain were lower，the loss of body weight was lower in the FTS group （P＜0.05），but the differences of WBC and serum amylase at 24 h after operation were not significant between the FTS group and conventional group（P＞0.05）. Conclusion The FTS is safe，economic，and effective in the treatment for cholecystolithiasis combined with calculus of CBD by combination of laparoscope and duodenoscope.
ObjectiveTo investigate the feasibility of thoracolapascopic esophagectomy (TLE) without routine nasogastric (NG) intubation for patients with esophageal cancer (EC). MethodsClinical data of 78 EC patients under-going TLE without perioperative NG intubation in Affiliated Cancer Hospital of Zhengzhou University from January to September 2013 were analyzed (non-NG intubation group, including 48 male and 30 female patients with their age of 61.1± 8.5 years). Seventy-eight EC patients undergoing TLE with routine NG intubation for 7 days in 2012 were chosen as the control group (NG intubation group, including 50 male and 28 female patients with their age of 60.3±7.0 years). Operation time, postoperative morbidity, gastrointestinal functional recovery and patient discomfort were compared between the 2 groups. ResultsThere was no in-hospital death in either groups. There was no statistic difference in the incidences of pulmonary infection (16.7% vs. 19.2%, P=0.676), anastomotic leakage (1.3% vs. 2.6%, P=0.560) or NG tube replacement (3.8% vs. 2.6%, P=0.649) between non-NG intubation group and NG intubation group. Time for recovery of intestinal motility (2.5± 1.1 days vs. 4.3±1.2 days, P < 0.05) and time for air evacuation (3.6±1.7 days vs. 5.8±2.1 days, P < 0.05) of non-NG intubation group were significantly shorter than those of NG intubation group. Ninety-seven percent of the patients (76/78)in NG intubation group had uncomfortable feeling including dry mouth and sore throat, and only 6% of the patients (5/78) in non-NG intubation group had nausea. All the patients were followed up for 3 months after discharge. There was no intestinal obstruction, pneumonia or late anastomotic leakage during follow-up. ConclusionTLE without routine NG intubation is safe and feasible for EC patients, which can not only reduce patients' discomfort but also improve early recovery of gastrointestinal function.
Objective To explore the application of fast track surgery (FTS) mode through multidisciplinary cooperation for the perioperative period of liver cancer. Methods A total of 188 patients with liver cancer treated between April and December 2014 were randomly divided into two groups: FTS group (n=94) and control group (n=94). The FTS group was treated with multidisciplinary cooperative FTS mode, while the control group was treated with traditional perioperative treatment. The self-care ability of daily life, pain, ambulation time and frequency, anal exhaust time, defecation time, hospital stay, hospitalization expenses and readmission rate were compared between the two groups. Results Compared with the control group, patients in the FTS group had a better ability of self-care one to three days after surgery, more reduced pain 8, 24 and 48 hours after surgery, more frequent ambulation and longer ambulation time three days after surgery, shorter time of defecation and exhaust, shorter hospital stay and lower hospitalization expenses. All the above differences were statistically significant (P<0.05). The readmission rate, self-care ability four to seven days after surgery, pain scores 72 and 96 hours after surgery were not significantly different (P>0.05). Conclusion Multidisciplinary cooperative FTS mode for liver cancer perioperative rehabilitation can improve patients’ self-care ability, promote a speedy recovery, reduce hospitalization costs, save medical resources and improve disciplinary teamwork ability.
Objective To explore the effect of fast track rehabilitation in patients with gastric cancer during perioperative period. Methods Eighty patients were randomly divided into conventional method group （n=40） and fast track rehabilitation group （n=40）, and to compare the levels of total lymphocyte count （TLC） , C-reaction protein （CRP），IgG， IgM， IgA， CD3＋， CD4＋， CD8＋， and CD4＋/CD8＋ in serum on the days of 1 d before operation and 1 and 3 d after operation，and to record the duration of fever，first ventilation time of flatus， postoperative hospital stay time，and the postoperative complications. Results The first ventilation time after operation was advanced in patients of fast track rehabilitation group， and the postoperative fever time and hospital stay time after operation of patients was shorter in fast track rehabilitation group than that in conventional method group （P＜0.05）. The incidence difference of complications in two groups had not statistic significance （P＞0.05）. The TLC on 1 d after operation were lower than that on 1 d before operation in two groups, and the CRP values of 1 d after operation were higher than that of 1 d before operation in two groups （P＜0.01）. Compared with 1 d before operation, the CRP value on 3 day after operation in fast track rehabilitation group was lower than that in conventional method group, and the levels of IgG, IgM， IgA， CD3＋， CD4＋， CD8＋， and CD4＋/CD8＋ were higher than that in conventional group （P＜0.05）. Conclusions Fast track surgery applied to patients with gastric cancer during perioperative period is safe and efficient， which can mitigate the immunologic impairment of patients and accelerate postoperative rehabilitation．
ObjectiveTo evaluate the efficacy of tubless therapy for pulmonary bulla resection under the concept of fast track surgery.MethodsWe retrospectively analyzed the clinical data of 45 patients (29 males and 16 females at an average age of 26.1 years) with pulmonary bullae in our hospital between January 2015 and December 2017. These patients were divided into two groups. Among them, 25 patients were treated with preoperative gastric tubes and catheters, tracheal intubation anesthesia and postoperative drainage tubes (a tube group). And 20 patients were treated with no preoperative gastric tube or catheter, sublaryngeal anesthesia and no postoperative drainage tube (a tubless group). ResultsThere was a statistical difference in postoperative pain index (2.60±1.14 vs. 5.16±1.24, P<0.001) and larynx complication (P=0.00) between the two groups. Shorter period of epidural analgesic tubes (1.40±0.50 d vs. 2.84±0.75 d, P<0.001), shorter operation and anesthesia time (15.00±2.59 min vs. 18.56±2.10 min, P<0.001; 95.30±4.38 min vs. 105.50±4.59 min, P<0.001), shorter hospital stay (9.45±1.66 d vs. 12.80±1.87 d, P<0.001), and less expense (20 245.96±1 113.02 yuan vs. 22 147.06±1 735.01 yuan, P<0.001) in the tubless group were found compared with the tube group. But there was no statistical difference in incidence of complication of lung (P=0.43) between the two groups.ConclusionTubless therapy in the treatment of pulmonary bulla resection can accelerate the postoperative recovery with shorter hospital stay and less expense, and is an advantageous treatment.
ObjectiveTo investigate the feasibility and advantage of the da Vinci S Surgical System in operation of the mediastinal tumor without chest tube. MethodsFrom March 2011 up to March 2015, 39 patients in our hospital with mediastinal tumor underwent resection without a chest tube by da Vinci System were as a no chest tube group with 24 males and 15 females at age of 47.28 (18-73) years. In the same period, 50 patients with mediastinal cyst underwent resection with a chest tube insertion by da Vinci System were as a chest tube group with 25 males and 25 females at age of 49.24 (22-82) years. Clinical data of the two groups were collected and compared. ResultThere were statistical differences in mean operative time (61.97±16.41min vs. 79.90±33.19 min, P=0.003), time of ICU stay (1.23±0.48 d vs. 2.16±0.82 d, P=0.000), time of postoperative hospitalization (3.77±1.16 d vs. 5.62±2.22 d, P=0.000), and visual analogue scale (VAS) score (3.05±1.76 vs. 4.54±1.83). The clinical results in the no chest tube group were better than those in the chest tube group. All the procedures were successfully completed by da Vinci System in all the patients without conversions and any compilcation. ConclusionIt's safe and beneficial for patients without a chest tube after a mediastinal tumor resection with da Vinci S Surgical System with shorter hospital stay.
ObjectivesTo systematically review the efficacy and safety of fast track surgery in perioperative patients with adrenalectomy.MethodsPubMed, EMbase, Web of Science, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy and safety of fast track surgery in perioperative patients with adrenalectomy from inception to January 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 11 RCTs involving 1 034 patients were included. The results of meta-analysis showed that: fast track surgery in perioperative patients with adrenalectomy could shorten first exhaust time (MD=−17.16, 95%CI −21.86 to −12.46, P<0.000 01), postoperative catheter indwelling time (MD=−43.44, 95%CI −46.65 to −40.23, P<0.000 01) and drainage tube indwelling time (MD=−39.91, 95%CI −57.58 to −22.23, P<0.000 01), and reduce the incidence of complications after adrenalectomy (OR=0.26, 95%CI 0.1 to 0.39, P<0.000 01). There were no statistically differences in operation time (MD=−1.18, 95%CI −3.22 to 0.86, P=0.26) and blood loss (MD=0.25, 95%CI −2.84 to 3.34, P=0.88) between two groups.ConclusionsCurrent evidence shows that, compared with the conventional rehabilitation group, fast track surgery can promote postoperative recovery of patients with adrenalectomy more safely and effectively, which has clinical promotion value. Due to limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusion.
ObjectiveTo investigate the application of fast track surgery (FTS) in hepatobiliary surgery, and discuss the postoperative stress response and its efficacy and safety assessment. MethodsA total of 171 patients undergoing different hepatobiliary operations in our ward from August 2008 to Jule 2011 were randomly divided into control group (n=89) and FTS group (n=82). Patients in the FTS group received the improved methods while those in the control group received traditional care. A series of indicators such as hospital stay, hospital expense, duration of intravenous infusion, postoperative complications, and the C-reaction protein (CRP) and interleukin-6 (IL-6) levels in serum were observed postoperatively. ResultsFor the FTS and control group, the first exhaust time was respectively (2.4±0.3) and (3.3±0.6) days, postoperative hospital stay was (9.1±2.7) and (14.1±4.1) days, hospitalization expense was (16 432±3 012) and (21 612±1 724) yuan, all of which had significant differences (P<0.05). Before surgery and on the 1st, 3rd, 5th and 7th day after surgery, IL-6 serum level for the FTS group was respectively (8.57±2.58), (30.21±12.44), (17.41±11.73), (11.14±7.12), and (10.50±5.19) ng/L, and for the control group was respectively (9.13±2.99), (51.31±19.50), (36.82±12.33), (28.23±9.18), and (15.44±4.33) ng/L. There was no significant difference in the preoperative IL-6 level between the two groups (P>0.05), while IL-6 level was significantly lower in the FTS group than the control group after surgery (P<0.05). Before surgery and on the 1st, 3rd, 5th and 7th day after surgery, CRP serum level for the FTS group was respectively (18.41±4.01), (69.74±26.03), (45.52±20.50), (39.14±11.23), and (29.03±6.47) μg/L, and for the control group was respectively (17.74±2.11), (99.23±23.50), (86.81±17.34), (68.22±15.60), and (37.70±9.55) μg/L. There was no significant difference in the preoperative CRP level between the two groups (P>0.05), while CRP level was significantly lower in the FTS group than the control group after surgery (P<0.05). Postoperative complication rate after surgery was not significantly different between the two groups (P>0.05). ConclusionThe application of FTS in some hepatobiliary operations is effective and safe by decreasing the stress response.
ObjectiveTo investigate the feasibility and effectiveness of fast track surgery (FTS) in rib fracture fixation. MethodsFifty-two patients with chest trauma who underwent rib fracture fixation surgery in Mingji Affiliated Hospital of Nanjing Medical University from October 2010 to June 2013 were enrolled in this study. All the patients were divided into FTS group and control group. In the FTS group, there were 26 patients including 22 males and 4 females with their age of 45.62±8.20 years, who received FTS strategies. In the control group, there were 26 patients including 21 males and 5 females with their age of 46.42±7.60 years, who received traditional treatment strategies. Postoperative visual analogue scale (VAS), gastrointestinal function recovery time, postoperative hospital stay and hospitalization cost were compared between the 2 groups. ResultsVAS at 6 hours, 24 hours and 48 hours postoperatively of FTS group (4.5±0.3, 4.2±0.2, 3.2±0.1) were significantly lower than those of the control group (6.5±0.1, 6.1±0.3, 4.8±0.2) respectively (P < 0.05). Gastrointestinal function recovery time of FTS group (0.8±0.2 days) was significantly shorter than that of the control group (1.5±0.5 days, P < 0.05). Length of hospital stay (21.0±2.6 days) and hospitalization cost (5.18±0.75 ten thousand yuan) of FTS group were significantly shorter or lower than those of the control group (26.2±3.4 days and 5.78±0.64 ten thousand yuan) respectively (P < 0.05). ConclusionFTS strategies can effectively reduce postoperative VAS, shorten length of hospital stay, decrease hospitalization cost, and promote postoperative recovery of rib fracture patients.
ObjectiveTo investigate the safety, feasibility, and efficacy of fast track surgery (FTS) in gastrointestinal tract injury. MethodsThe data of 61 patients with gastrointestinal tract injury from July 2007 to July 2013 were retrospectively analyzed, among whom 29 patients were received FTS (FTS group) and 32 patients were received conventional care (control group). The first flatus and defecation time, hospital stay, rates of wound infection and lung infection, and the mortality were compared between these two groups. ResultsThe average first flatus and defecation time and the average hospital stay in the FTS group were significantly shorter than those in the control group (2.21 d versus 3.16 d, P=0.000; 7.45 d versus 9.78 d, P=0.000). The rate of lung infection in the FTS group were significantly lower than that in the control group[3.4% (1/29) versus 21.9% (7/32), P=0.033]. The rate of wound infection and the mortality had no significant differences between the FST group and the control group[3.4% (1/29) versus 15.6% (5/32), P=0.111; 0(0/29) versus 3.1% (1/32), P=0.337]. ConclusionsFTS is safe and effective among those gastrointestinal tract injury patients who visited the hospital in time and injury limited. FTS could promote defecate, shorter the hospital stay, and don't increase the complications and mortality.