Postoperative Intestinal Function Recovery Research Articles

Application Value of High-Quality Nursing in Operating Room in Rectal Cancer Operation and its Influence on Postoperative Rehabilitation.

To study the value of high-quality care in operating room during operation of patients with rectal cancer and the effect of this nursing model on postoperative rehabilitation. This study recruited 72 patients with rectal cancer, including 36 in the control group and 36 in the observation group. Patients in the control group received routine care, and those in the observation group received high-quality care in operating room. The anxiety score (5.50 ± .77 vs 10. 08 ± 1.13), stress score (6.97 ± .60 vs 8.61 ± .99), and depression score (4.02 ± .65 vs 5.50 ± .91) in the observation group were less than the control group after treatment (P < .05). The measured values of diastolic blood pressure (73.19 ± 1.96 vs 86.13 ± 2.0), systolic blood pressure (121.08 ± 1.62 vs 130.63 ± 2.84), heart rate (73.05 ± 1.63 vs 87.11 ± 2.91) and adrenaline E(E) (58.40 ± 3.02 vs 61.42 ± 3.86) in the observation group were less than the control group after treatment (P < .05). The cooperation degree (94.44 vs 75.00) in the observation group was greater than the control group, but the operation time (308.47 ± 9.92 vs 339.47 ± 12.70), postoperative intestinal function recovery time (16.30 ± 1.14 vs 30.94 ± 2.10) and length of stay (10.47 ± 1.85 vs 13.33 ± 1.95) were all shorter than the control group (P < .05). The nasopharyngeal temperature in the observation group was greater than the control group at 30 minutes during operation (36.16 ± .50 vs 35.19 ± .40) and after operation, and fear score (2.22 ± .42 vs 3.63 ± .72) was less than the control group (P < .05). The application of high-quality care in the operating room during rectal cancer surgery has a significantly good clinical outcome.

Transversus abdominis plane block improves postoperative recovery following cesarean delivery under general anesthesia: A propensity score matched retrospective cohort study.

To evaluate the effects of transversus abdominis plane (TAP) block on postoperative recovery 24 h after cesarean delivery under general anesthesia. A propensity-score-matched, retrospective cohort study was used. A total of 173 pregnancies resulting in elective cesarean delivery under general anesthesia between March 2021 and March 2022 were analyzed retrospectively. Patients receiving TAP block were compared with those receiving only intravenous analgesia. The Quality of Recovery 15 (QoR-15) score, assessed 24 h postoperatively using a 15-item questionnaire, was the primary outcome. Secondary outcomes included time to first ambulation, time to first flatus postoperatively, ability to tolerate ambulation, visual analog scale (VAS) score, hospitalization cost, and postoperative nausea and/or vomiting. The total QoR-15 score 24 h postoperatively in the TAP group was significantly higher than in the Control group (P < 0.001). Patients in the TAP group had higher Bruggemann comfort scale scores (P < 0.001), could better tolerate early postoperative ambulation (P < 0.001), and had shorter time to first ambulation (P < 0.001) and flatus (P < 0.001). Correlation analysis demonstrated an inverse relationship between the cumulative VAS pain scores, time to first postoperative ambulation, time to first flatus, and total QoR-15 score 24 h postoperatively. Following cesarean delivery under general anesthesia, TAP block combined with intravenous analgesia can improve postoperative recovery and shorten the time to postoperative ambulation and recovery of intestinal function.

Retrospective comparison of clinical outcomes of robotic-assisted laparoscopic partial nephrectomy through transabdominal or retroperitoneal approaches in patients with T1b renal tumor

BackgroundWe compared the intraoperative and postoperative outcomes of robotic-assisted laparoscopic partial nephrectomy (RALPN) via transabdominal or retroperitoneal approaches in patients with stage T1b renal cell carcinoma.MethodsThe medical records for 92 patients who underwent RALPN were retrospectively collected and data on their baseline demographics, duration of operation, duration of renal artery clamping, intraoperative blood loss, recovery time of intestinal functions, surgical margin positive rate, as well as postoperative complications were analyzed.ResultsOf the 92 enrolled patients, 43 and 49 patients were subjected to RALPN via the transabdominal and retroperitoneal approaches, respectively. All patients successfully completed the operation. Baseline characteristics for the transabdominal and retroperitoneal groups were comparable. Differences in operative time, renal artery clamping time, intraoperative blood loss, positive rate of surgical margin, and incidences of postoperative complications between the two approaches were insignificant. The recovery time of intestinal function after operation was significantly shorter in patients subjected to the retroperitoneal approach, relative to those subjected to transabdominal approach (p < 0.001).ConclusionsApplication of RALPN via transabdominal or retroperitoneal approaches showed comparable clinical outcomes in patients with stage T1b renal cell carcinoma. The retroperitoneal approach was superior to the transabdominal approach in terms of postoperative intestinal function recovery.

Bowel Sounds Detection Method and Experiment Based on Multi-feature Combination

Bowel sounds is an important indicator to monitor and reflect intestinal motor function, and traditional manual auscultation requires high professional knowledge and rich clinical experience of doctors. In addition, long-time auscultation is time-consuming and laborious， which may lead to misjudgment caused by subjective error. To solve the problem, firstly, the wavelet transform is used to preprocess the bowel sounds signal for noise reduction and enhancement. Secondly, three typical features of intestinal sound were extracted. According to the combination of these features, a three-stage decision was designed to carry out multi-parameter and multi-feature joint threshold detection. This algorithm realized the detection of bowel sound signal and the location of its start and end points, making it possible that the complete bowel sound signal was extracted effectively. In this study, a large number of clinical data and label of bowel sounds were collected, and a new effective evaluation method was proposed to verify the proposed method. The accuracy rate is 83.51%. Results of this study will provide systematic support and theoretical guarantee for the diagnosis of intestinal diseases and the monitoring of postoperative intestinal function recovery of patients.

Clinical Effect of Retroperitoneal Laparoscopic Radical Nephrectomy on Renal Cell Carcinoma, the Influence of Renal Function, and the Influencing Factors of Recurrence.

Renal cell carcinoma is abbreviated as renal carcinoma, and its clinical symptoms are basically hematuria, lumbago, and abdomen bump. As people's lifestyles change, the incidence of renal carcinoma continues to rise due to factors such as smoking and obesity. At present, surgical treatment is mostly used in clinical practice. Traditional open radical nephrectomy (ORN) is one of the main methods for clinical treatment of renal carcinoma. However, due to its large wound and large amount of intraoperative blood loss, the renal function of patients after surgery is poor, which is not conducive to the postoperative recovery of patients. Retroperitoneal laparoscopic radical nephrectomy (RLRN) has been widely used in the surgical treatment of renal cancer due to its advantages of small wound, less bleeding, and rapid recovery. The purpose of this study was to investigate the efficacy of RLRN in the treatment of renal cancer patients and its effect on renal function and to analyze the related factors affecting postoperative recurrence of patients. We adopt ORN and RLRN, two kinds of treatment, in patients with renal cancer surgery way, contrast analysis of the two groups of operation time, intraoperative blood loss, postoperative intestinal function recovery time, drainage tube indwelling time, length of hospital stay, and other clinical indicators and renal function indexes and use the single factor analysis and multifactor analysis, the relevant factors that affect kidney cancer patients with postoperative recurrence. The results showed that, compared with ORN treatment, RLRN treatment of renal cancer patients has a short operation time, less trauma, quick recovery after surgery, and fewer complications and can effectively alleviate the renal function injury and the body's inflammatory response, which is worthy of promotion. Postoperative recurrence was related to age, tumor diameter, TNM stage, surgical method, and postoperative immunotherapy.

Comparison of Deep and Moderate Neuromuscular Blockade on Intestinal Mucosal Barrier in Laparoscopic Gastrectomy: A Prospective, Randomized, Double-Blind Clinical Trial.

Deep neuromuscular blockade (NMB) improves the surgical conditions and is benefit for the postoperative recovery after laparoscopic surgery. However, the mechanisms of deep NMB in promoting the recovery of intestinal function have not been completely investigated. The objective of our study was to determine the impact of the deep NMB and moderate NMB strategy on the intestinal barrier function after laparoscopic gastrectomy. We collected patients undergoing elective laparoscopic gastrectomy. Patients were randomized to deep NMB (post-tetanic count 1–2) vs. moderate NMB (train-of-four count 1–2) during the surgery. Primary outcomes were time to flatus, serum diamine oxidase (DAO) and D-lactate, and gut microbiota. Other outcomes were surgical condition scores, postoperative visual analog pain scores, and length of hospital stay. Ninety patients in deep NMB group and sixty patients in moderate NMB group completed the study. Main results showed that the time to flatus was decreased in deep NMB group (74 ± 32 h) than that in moderate NMB group (93 ± 52 h, P = 0.006). The level of serum D-lactate was statistically increased in the moderate NMB group than that in the deep NMB group (1,209 ± 224 vs. 1,164 ± 185 ng/ml, p < 0.001). But no significant differences could be detected in the level of DAO between the groups. Additionally, the 16s rRNA analysis indicated that gut microbiota were similar in Alpha diversity but distinct in Beta diversity. Furthermore, the beneficial bacteria, such as genus Lactobacillus and Bifidobacterium, were more abundant in the deep NMB group, while the potentially harmful bacteria were more abundant in the moderate NMB group. Our findings suggested that the intestinal mucosal barrier and gut microbiota were better preserved in deep NMB, which greatly improved the postoperative recovery of intestinal function after laparoscopic gastrectomy.

Application of electric tube stapler in laparoscopic colorectal tumor surgery

Objective: To investigate the application of electric tube stapler in laparoscopic colorectal tumor surgery. Methods: A descriptive case series study was conducted. Clinical data of patients who underwent laparoscopic colorectal surgery in Peking Union Medical College Hospital in August 2021 using domestic electric tube stapler were collected to analyze the occurrence of postoperative anastomotic leakage, anastomotic bleeding and other complications as well as postoperative intestinal function recovery. Results: A total of 11 patients with colorectal tumor were enrolled in this study, including 8 males and 3 females. Eight patients underwent laparoscopic low anterior resection (1 patient underwent protective ileostomy), and three patients underwent laparoscopic sigmoid carcinoma radical resection. During operation, power system failure of stapler occurred in 1 patient, and the replacement manual device was used to complete the anastomosis. No anastomotic leakage or bleeding occurred in the cohort of patients. There was no conversion to laparotomy or conventional anastomosis. One patient developed acute myocardial infarction 2 days after surgery. The average time to the first flatus after surgery was (2.4±0.8) days and the average length of hospital stay was (10.0±6.1) days. Conclusions: The application of electric tube stapler in laparoscopic colorectal tumor surgery has many advantages, such as safe and effective anastomosis, low morbidity of postoperative complications, and rapid recovery of intestinal function. Domestic electric tube stapler can be applied in minimally invasive surgery for colorectal tumor.

Clinical Evaluation of Laparoscopic Cholecystectomy in the Treatment of Acute Cholecystitis in the Elderly

To evaluate the efficacy of laparoscopic cholecystectomy in the treatment of senile acute cholecystitis. A total of 96 elderly patients with acute cholecystitis admitted to our hospital from January 2014 to January 2019 were selected and all the patients were divided into groups according to their treatment timing. Patients within 3 d from the onset of the disease to the operation time were selected as Group A. Patients with an onset time of 3 d to 3 w of surgery were treated as Group B, while patients with an onset time of more than 3 w of surgery were treated as Group C. The operative time, intraoperative blood loss, postoperative intestinal function recovery time and hospital stay time were compared among the groups. Postoperative complications such as bleeding, pulmonary infection, abdominal infection, bile leakage and intestinal fistula, deep vein thrombosis and myocardial infarction were compared among all groups. Compared with Group A, there were no significant differences in intraoperative blood loss, operative time, postoperative bowel function recovery and length of hospital stay in Group B (p>0.05). Compared with group A and B, patients in Group C had higher operative time, intraoperative blood loss, postoperative intestinal function recovery and hospital stay (p 0.05). Early laparoscopic cholecystectomy can reduce intraoperative blood loss, operation time, hospital stay and recovery time of intestinal function in elderly patients with acute cholecystitis.

A randomized controlled trial of Chinese traditional medicine Dachengqi Decoction in the treatment of postoperative intestinal function recovery.

BackgroundIntestinal dysfunction is not conducive to the recovery of patients after surgery. It is particularly important to restore the intestinal function as soon as possible. In recent years, ultrasonic drug penetration therapy as a new type of non-invasive therapy has been used to solve this problem, but its efficacy has not been confirmed.MethodsSingle-centre, parallel, randomized controlled clinical trial in China that included 184 patients undergoing laparoscopic gastrointestinal surgery. Ninety-one participants were randomly assigned to low-frequency ultrasound and electric pulses for transdermal drug delivery with Dachengqi Decoction (DCQD) (intervention group), and 90 were assigned to the control group after laparoscopic gastrointestinal surgery. The primary outcome was time to first flatus after surgery (by patient’s subjective feeling). Secondary outcomes assessed the recovery time of bowel movement, time of the first defecation, postoperative gastrointestinal complications (e.g., nausea, vomit, and bloating), days of hospitalization and treatment costs.ResultsOf 184 patients, 181 (98.4%) completed the trial. The sociodemographic characteristics and efficiency data were comparable in the two groups at baseline. The intervention group had a shorter mean time of bowel movement recovery than the control group [29.4 h (IQR, 22.0–35.0 h) vs. 33.7 h (IQR, 24.0–40.0 h; P=0.005)] and a shorter mean time to first flatus after surgery [35.8 h (IQR, 23.1–46.6 h) vs. 46.7 h (IQR, 25.9–61.3 h; P=0.012)]. Postoperative gastrointestinal reactions (e.g., nausea, vomit, and bloating) occurred in 28.6% in the intervention group and 43.3% in the control group (P=0.038). Two patients in the intervention group had electrical tingling sensations, and one patient had a skin rash during the treatment. There were no significant differences in the occurrence rates of AEs or SAE, days of hospitalization and treatment costs between the two groups.ConclusionsLow-frequency ultrasound and electric pulses for transdermal drug delivery with DCQD can shorten the time of bowel movement recovery and accelerate first anal exhaust after laparoscopic gastrointestinal surgery.Trail registrationChictr.org.cn Identifier: ChiCTR-IPR-17013630.

Efficacy analysis on laparoscopic simultaneous resection of primary colorectal cancer and liver metastases

Objective: To investigate the short-term outcomes of laparoscopic simultaneous resection of primary colorectal cancer and liver metastases in patients with resectable synchronous colorectal liver metastases (SCRLM). Methods: A descriptive case series study was performed. Clinicopathological data of patients with SCRLM who underwent laparoscopic simultaneous resection of colorectal cancer and liver metastases in Zhongshan Hospital between December 2015 and September 2018 were retrieved from a prospective colorectal cancer database. Perioperative presentations and short-term outcomes were analyzed. Results: A total of 53 patients were enrolled with average age of(61.7±11.3) years. Among them, 32 were male (60.4%) and 21 were female (39.6%). Twenty-five patients (47.2%) were American Society of Anesthesiologists (ASA) grade I and 28 (52.8%) were grade II. All the patients completed laparoscopic simultaneous resection without conversion. The average operation time was (320.2±114.5) min. The estimated blood loss was 150.0 (45.0-2000.0) ml, and only 2 cases (3.8%) received intraoperative transfusion. Postoperative pathologic results revealed that the average primary tumor size was (5.4±1.9) cm; 4 cases (7.5%) were T1-2 stage and 48 cases (90.6%) were T3-4 stage; 40 patients (75.5%) had lymph node metastasis; 19 (35.8%) had vascular involvement; 24 (45.3%) had neural invasion. The median number of liver metastases was 1.0 (1-8), and the average size of largest liver metastases was (3.0±1.9) cm. The median margin of liver metastases was 1.0 (0.1-3.5) cm, and only 1 case was R1 resection. The average time to the first postoperative flatus was (67.9±28.9) h, and the average time to the liquid diet was (107.0±33.8) h. The average postoperative indwelling catheterization time was (85.6±56.4) h. The average postoperative hospital stay was (9.2±4.4) d, and the average cost was (82±26) thousand RMB. No death within postoperative 30-day was found. The morbidity of postoperative complication was 32.1% (17/53) and 3 patients developed grade III to IV complications which were improved by conservative treatment. The median follow-up period was 23.2 months. During follow-up, 19 patients (35.8%) developed recurrence or metastasis, and 4 (7.5%) died. The 1- and 2-year disease-free survival (DFS) rates were 68% and 47% respectively, and the 1- and 2-year overall survival rates were 95% and 86% respectively. Conclusions: Laparoscopic simultaneous resection of primary colorectal cancer and liver metastases is safe and feasible in selected patients with SCRLM. Postoperative intestinal function recovery is enhanced, and morbidity and oncological outcomes are acceptable.

Clinical Efficacy Analysis of Two Different Surgical Approaches to Laparoscopic Radical Cystectomy with Urinary Diversion for Invasive Bladder Cancer

Objective: The present study aimed to compare the efficacy, and advantages and disadvantages of laparoscopic radical cystectomy + extraperitoneal bilateral ureterocutaneostomy versus laparoscopic radical cystectomy + ileal cystoplasty (Bricker procedure) in the treatment of invasive bladder cancer. Method: Forty-five patients (retrospectively registered) with grade II–III bladder invasive urothelial carcinoma were divided into two groups to compare clinical efficacy, operative duration and blood loss, postoperative intestinal function recovery, length of hospitalization, and complications. Those in the ureterocutaneostomy group (n=25) were treated using laparoscopic radical cystectomy + extraperitoneal bilateral ureterocutaneostomy, while those in the ileal cystoplasty group (n=20) were treated using laparoscopic radical cystectomy + ileal cystoplasty. Results: Laparoscopic radical cystectomy + extraperitoneal bilateral ureterocutaneostomy shortened the operation, improved patient tolerance, and decreased postoperative intestinal function recovery time. However, its long-term clinical efficacy needs further study using larger sample sizes to confirm these results. Conclusion: Results of this study demonstrated that extraperitoneal bilateral ureterocutaneostomy after cystectomy had advantages of less trauma, a shorter learning curve, less surgical bleeding, and quicker postoperative recovery. Although early and mid-term follow-up revealed a slightly higher incidence of hydronephrosis, the severity of complications was not high in most patients. Nevertheless, the long-term clinical efficacy of this procedure needs further study using larger sample sizes.

MP04-17 SUPRAPUBIC-ASSISTED LAPAROENDOSCOPIC SINGLE-SITE SURGERY VERSUS OPEN URETEROVESICAL REIMPLANTATION USING INSERTION METHOD

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I (MP04)1 Apr 2020MP04-17 SUPRAPUBIC-ASSISTED LAPAROENDOSCOPIC SINGLE-SITE SURGERY VERSUS OPEN URETEROVESICAL REIMPLANTATION USING INSERTION METHOD Guoxi Zhang*, Xiaofeng Zou, Liang Wang, and Rihai Xiao Guoxi Zhang*Guoxi Zhang* More articles by this author , Xiaofeng ZouXiaofeng Zou More articles by this author , Liang WangLiang Wang More articles by this author , and Rihai XiaoRihai Xiao More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000818.017AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To compare the efficacy of suprapubic-assisted laparoendoscopic single-site surgery (SA-LESS) and open ureterovesical reimplantation using insertion method, and to evaluate its clinical value. METHODS: Thirty patients who underwent SA-LESS ureterovesical reimplantation and 32 patients who underwent open ureterovesical reimplantation using insertion method were selected from July 2010 to December 2016 in the Department of Urology, First Affiliated Hospital of Gannan Medical College. To collect the material such as gender, age, preoperative water accumulation, operation time, intraoperative blood loss, postoperative complications, postoperative day 1 visual analog simulation score (Visual Analogue Scale/Score, VAS), postoperative analgesia time, postoperative ventilation time, postoperative drainage withdrawal time, postoperative catheter indwelling time, postoperative hospital stay. The main clinical items were compared and analyzed. All patients were reexamined 3 months, 6 months and 12 months after operation, and then every year. The follow-up included urinary color Doppler ultrasound, urinary analysis, renal function, intravenous urography and cystography, and patient scar assessment questionnaire. The differences of intraoperative and postoperative items between the two groups were compared. RESULTS: All 30 patients in the SA-LESS group were successful with no open surgery, no addtion port. 32 cases of the open group were successfully operated. No significant differences were found in operative time [(116.7±25.2)min vs (107.9±16.4)min, P=0.065], and postoperative catheter indwelling time [(8.0±1.8)d vs (8.9±2.1)d, P=0.088] between the two groups. Significant differences in intraoperative blood loss [(61.2±37.8)ml vs (110.8±39.1)ml, P=0.000], intraoperative incision length [(2.7±0.3)cm vs (12.8±2.4)cm, P=0.000], and postoperative intestinal function recovery time [(36.0±13.9)h vs (50.2±18.4)h, P=0.001] between the two groups were found. Significant differences in VAS score on the first postoperative day [(2.1±1.0) vs (3.8±1.2), P=0.001], VAS score on the third day after surgery [(1.0±1.0) vs (1.8±1.2), P=0.009], and postoperative analgesia time [(22.8±14.6)h vs (37.2±14.5)h, P=0.000] between the two groups were also found. There were significant differences in postoperative drainage tube indwelling time [(4.4±1.5)d vs (5.9±2.4)d, P=0.003],and postoperative hospital stay [(9.1±2.0)d vs (11.0±3.1)d, P=0.003] between the two groups. Complications occurred in 2 patients in the SA-LESS group, all of which were anastomotic leakage. In the open group, 9 patients had complications after operation. Among them, 4 patients had anastomotic leakage and 5 patients developed a wound infection. Significant difference was found in complication rates (x2=4.885, P=0.027). The total PSAQ of the SA-LESS group was lower than that of the open group at 3 months, 6 months and 1 year [(61.9±8.7) vs (85.9±8.3), P=0.000; (48.2±6.4) vs (74.0±8.2), P=0.000; (37.5±4.8) vs (64.9±6.3), P=0.000]. The SA-LESS group was followed up for 24-90 months, and the open group was followed up for 28-91 months. All cases were followed up for B-ultrasound and IVU, and postoperative hydronephrosis was improved to varying degrees. All cases were followed up for cystoscopy and no ureteral reflux was seen. CONCLUSIONS: SA-LESS ureterovesical reimplantation using insertion method, can result in small trauma, rapid postoperative recovery, less complications, and better cosmetic results with stable, long-term postoperative effect, which is worthy of application in clinic. Source of Funding: National Nature Science Foudation of China (Grant no. 81760462) © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e38-e39 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Guoxi Zhang* More articles by this author Xiaofeng Zou More articles by this author Liang Wang More articles by this author Rihai Xiao More articles by this author Expand All Advertisement PDF downloadLoading ...

Comparison of laparoscopic left ureterolithotomy between the middle colon and the lateral colon in the early stage of learning

Objective To compare the efficacy of laparoscopic ureterolithotomy via the mid-colon approach and laparoscopic ureterolithotomy via the traditional lateral colon approach for inexperienced surgeons. Methods The data of 59 patients with left ureteropelvic junction stenosis admitted to Luoyang central hospital affiliated to Zhengzhou university from March 2014 to March 2018 were retrospectively analyzed. Thirty-two patients were treated by conventional lateral colon approach and 27 patients were treated by mesocolon approach. The perioperative results and follow-up data were compared between the two approaches. The operative time, intraoperative blood loss, postoperative intestinal function recovery, postoperative pain and so on were compared between the two groups. Results The operation time of the middle colon approach group was significantly shorter than that of the conventional side colon approach group(P 0.05). Conclusions The mesocolon approach is straight through the middle colon. Exposure to ureter can save the time needed for the free colon. Even for surgeons with limited experience, this method is safe and feasible, and has the same success rate as traditional lateral colon surgery. Key words: Ureteral Calculi; Laparoscopy; Lithotripsy

Effect of goal-directed fluid therapy on postoperative intestinal function recovery in the aged patients with rectal cancer

Objective To investigate the effect of intraoperative routine fluid therapy and goal-directed fluid therapy(GDFT) by FloTrac/Vigileo monitoring system on the recovery of intestinal function in aged patients with rectal cancer. Methods Sixty ASAⅠ~Ⅲ patients undergoing laparoscopic anterior resection of rectal cancer(Dixon operation), who were treated in the Third People's Hospital of Datong from August 2018 to May 2019 were selected and randomly divided into two groups according to the digital table, with 30 cases in each group.Group C received routine intraoperative fluid administration, and the total rate of fluid=deficit+ maintenance administration+ loss+ third space losses.Group G fluid therapy goal: cardiac index (CI) 2.5~4.0 L·min-1·(m2)-1, stroke volume variability (SVV) 13%, rapidly infused sodium lactate Ringer's injection 3 mL/kg(within 10 min via an infusion pump); if CI<2.5 L·min-1·(m2)-1, SVV<13%, infused dobutamine; if MAP<65 mmHg, CI≥2.5 L·min-1·(m2)-1, infused norepinephrine.Two groups were continously infused sodium lactate Ringer's injection 3 mL·kg-1·h-1.Equivalent volume 6% hetastarch was infused to supplement the blood loss.During the operation, Hb<80 g/L and red blood cells were transfused when bleeding continued.The total fluid intake, bleeding volume, urine volume, postoperative hospital stay days, postoperative intestinal function recovery(postoperative flatus time and eating time), the incidence of postoperative intestinal complications(postoperative inflammatory bowel obstruction, anastomotic leakage and anastomotic bleeding) were recorded.Intestinal fatty aid binding protein (iFABP) was measured at T0(before the induction), T1(at the end of surgery), T2(2 h after surgery), T3(24 h after surgery) by using ELISA kits. Results The intraoperative fluid intake was (2 051±466)mL in group C, and (1 811±413)mL in group G, there was statistically significant difference between the two groups(t=2.111, P=0.039). The postoperative exhaust time and hospitalization days in group G were 28.6(23.3, 32.1)h and 10.2(9.9, 12.1)d, respecticely, which were shorter than those in group C [32.6(27.1, 40.9)h and 11.6(10.7, 12.2)d] (Z=2.321, P=0.020, Z=2.435, P=0.015). The incidence of postoperative complications was 13%(4/30) in group C, and 10%(3/30) in group G, there was no statistically significant difference(P>0.05). The iFABP of group C at T1 and T2 after operation was significantly higher than those of group G(t=2.445, 3.098, P=0.018, 0.003). Conclusion GDFT can reduce intraoperative crystalloid infusion, promote early intestinal function recovery in elderly patients with rectal cancer, and reduce perioperative intestinal mucosal ischemic injury. Key words: Rectal neoplasms; Fluid therapy; Cardiac index; Stroke volume; Intestinal fatty aid binding protein; Intestinal mucosal; Postoperative complications; Aged

Influencing factors for postoperative recovery of intestinal function in neonates with congenital intestinal malrotation

Influencing factors for postoperative recovery of intestinal function in neonates with congenital intestinal malrotation

Efficacy of laparoscopic surgery on the treatment of Dong Type C adult biliary dilatation

Objective To investigate the technical and therapeutic effects of laparoscopic surgery for adult patients with Dong Type C bile duct dilatation. Methods A retrospective cohort study approach was used. The clinical data of 47 patients with Dong Type C adult biliary dilatation who underwent surgery in Fujian Provincial Hospital from January 2014 to December 2017 were collected. There were 12 males and 35 females. The age ranged from 16 to 68 years, with a median age of 30 years. According to different surgical methods, the patients were divided into the laparoscopic group (treated with laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy, n=21) and the open group (treated with traditional open operation, n=26). The intraoperative blood loss, complication rate, operation time, postoperative intestinal function recovery time and postoperative hospital stay were observed. Measurement data with normal distribution were expressed as mean ± standard deviation (Mean±SD) and analyzed by t test. Comparison of count data was done by the chi-square test. Results There was no perioperative deaths in either group. There was no significant difference in intraoperative blood loss and complication rate between the two groups (P>0.05). The operation time of the laparoscopic group was significantly longer than that of the open group[ (333.7±61.1) min vs (235.9±64.3) min], with statistically significant difference between graps (P=0.000). The recovery time for the intestinal function of the laparoscopic group was significantly shorter than that of the open group [(2.2±0.5) d vs (2.9±0.6) d], with statistically significant difference between groups (P=0.000). The postoperative hospital stay in the laparoscopic group was significantly shorter than the open group [(7.1±1.8) d vs (12.0±5.9) d], with statistically significant difference between groups (P=0.001). Conclusion For adult biliary dilatation patiens with Dong Type C, laparoscopic surgery is safe and feasible with the advantages of mini-invasive and quick recovery. Key words: Laparoscopes; Comparative effectiveness research; Biliary dilatation; Surgery treatment

Bowel plication in neonatal high jejunal atresia.

This study aimed to evaluate the efficacy of bowel plication as a part of the surgical treatment in neonatal high jejunal atresia.Between January 2013 and December 2016, 43 neonates with high jejunal atresia underwent surgical treatment at the Children's Hospital of Fudan University. According to the surgical procedures the patients underwent, the neonates were divided into a bowel plication group and a nonplication group. Eighteen neonates underwent proximal bowel plication after atretic segment resection and primary anastomosis. The other 25 neonates were in the nonplication group and underwent enteroplasty after atretic segment resection. Data were retrospectively analyzed, including gestational age, birth weight, concomitant diseases, age at surgery, duration of operation, length of total parenteral nutrition (TPN), postoperative intestinal function recovery (i.e., the time of the 1st oral feeding and when the oral feeding volume reached 40 mL/kg/3 h), length of hospital stay, growth and development, complications, and reoperations.No differences in gestational age, birth weight, concomitant disease, age at surgery, or duration of operation were found between the 2 groups. The time of the 1st oral feeding, the time when oral feeding volume reached 40 mL/kg/3 h, and duration of TPN for the bowel plication group were shorter than those for the nonplication group (9.4 ± 3.1, 14.6 ± 2.3, 9.2 ± 2.7 days, respectively, vs 13.5 ± 2.6, 17.6 ± 2.8, 14.3 ± 2.4 days, respectively, P < .05). The length of the hospital stay for the bowel plication group was significantly shorter than for the nonplication group (15.3 ± 3.1 days vs 18.5 ± 3.6 days, respectively, P < .05). In the bowel plication group, 1 patient (5.6%) underwent reoperation for intestinal stenosis resulting from neonatal necrotizing enterocolitis 1 year after the initial surgery. However, in the nonplication group, 5 patients (20%) underwent reoperation, including 3 for anastomotic stenosis and 2 for adhesive intestinal obstruction. Follow-up visits occurred for an average period of 2.8 years (6 months to 4.5 years). All infants thrived, and no differences in growth and development were found between the 2 groups.Bowel plication after atretic segment resection and primary anastomosis improves the clinical outcome for neonates with high jejunal atresia.

No Association between staging operation and the 5-Year Risk of Reoperation in Patients with Crohn\u2019s Disease

The aim of this study was to investigate the impact of staging operation on the risk of reoperation in patients with CD who underwent primary bowel resection. This was a retrospective study of 980 patients with CD who were hospitalized in Jinling Hospital Affiliated to Nanjing Medical University between January 1, 2001, and October 1, 2016. The patients were grouped according to staging operation (n = 64) and one-stage operation (n = 148). Postoperative intestinal function recovery time, postoperative short-term complications, and reoperation rates were compared between the two groups. There was significant difference in disease behavior between the staging operation group and the one-stage operation group. There was no significant difference in postoperative tolerance of enteral nutrition among groups (P > 0.05). Obvious differences were found in the comparison of the first time of exhaustion, defecation after operation, postoperative length of stay and postoperative complications among groups (all P < 0.05). There was no difference in the 5-year cumulative reoperation-free rates between the two groups (P > 0.05). In conclusion, surgical intervention at proper time and appropriate operation during operation are essential for patients with CD. It is believed that staging operation with ostomy followed by intestinal anastomosis is feasible when there are more than two risk factors for postoperative intra-abdominal infectious complications.

Effects of rapid rehabilitation nursing in postoperative intestinal function recovery of patients with laterally spreading tumor

Objective To discuss the effects of rapid rehabilitation nursing in postoperative intestinal function recovery of patients with laterally spreading tumor. Methods A total of 100 patients with laterally spreading tumor in Yantai Affiliated Hospital of Binzhou Medical University from July 2014 to July 2016 were selected and randomly divided into the rehabilitation group and the control group, 50 cases respectively. Patients in the control group were given the conventional nursing, while patients in the rehabilitation group received additional rapid rehabilitation nursing. Postoperative intestinal function recovery, body recovery and nursing satisfaction of patients in two groups were analyzed. Results Postoperative exhaust time, defecation time and food-intake time of patients in the rehabilitation group were significantly shorter than the control group (t=3.20, 5.26, 6.31; P<0.05) . Rehabilitation training time, ambulation time and hospital stay of patients in the rehabilitation group were shorter than the control group, with statistically significant differences between two groups (t=7.26, 5.48, 3.26; P<0.05) . Nursing satisfaction of patients in the rehabilitation group were 96.00%, which was higher than the control group (80.00%) ; there was statistically significant difference between two groups (χ2=6.06, P<0.05) . Conclusions Rapid rehabilitation nursing can effectively promote the recovery of intestinal function in patients after laterally spreading tumor resection, facilitate the recovery of the disease, shorten the hospitalization time, and improve the nursing satisfaction, so that it is worthy of further clinical application. Key words: Nursing care; Rapid rehabilitation; Laterally spreading tumor; Intestinal function recovery

Modified abdominal wall suspension system in gasless laparoscopy: a clinical application

Introduction: The gasless laparoscopic technique is easily operable, safe. and avoids complications of pneumoperitoneum. The suspension method from two celiac wall rods evolved to a single wall rod method, reducing one hanging rod on one side of the abdominal wall. This benefited the surgeon which reduced the inhibition of one less visible, space-consuming suspension rod, however remains a hindrance to the assistant’s optimal movement and visual field. Objective: To explore the feasibility and application value of a modified abdominal wall suspension system in standard gasless laparoscopic myomectomy. Materials and Methods: Women agreeing to participate were randomised into two arms. The standard conventional gasless method versus the modified abdominal wall lifting method. Results: A total of 100 women were randomised into two groups; the improvised technique (group 1) and the conventional technique (group 2). Surgical operating time (72.3 &#x00B1; 35.6 minutes [improved] and 82.7 &#x00B1; 31.9 minutes [conventional]) p p vs. conventional) were significantly reduced in the improvised technique group, as opposed to the conventional technique group. No significant difference was found between the two groups with regards to postoperative intestinal function recovery period or the postoperative hospital stay duration. Conclusion: The modified abdominal wall suspension method increases the surgeon’s operating space, making it more convenient and practical with significant rewarding postoperative surgical outcomes.