The value of laparoscopy in the elderly colorectal fast track surgery

doi:10.3877/cma.j.issn.2095-3224.2019.02.008

Abstract

Abstract:

Objective

To study the application of laparoscopy in the elderly colorectal enhanced recovery after surgery, and to evaluate its value.

Methods

Fifty elderly patients with colorectal cancer were randomly divided into two groups: enhanced recovery after surgery protocols and open surgery (groupⅠ: n=25), enhanced recovery after surgery protocols and laparoscopic surgery (group Ⅱ: n=25). Their perioperative related indicators were recorded and analyzed.

Results

In the time to anal exhaust and the tolerant time for semi-fluid diet intake, group Ⅱ recovered faster than group I. On the third and the seventh day after operation, the levels of CRP and IL-6 in group I was more significant than those in group Ⅱ (t=4.133, 3.915, 2.138, 5.298; all P<0.05). On the third day after operation, the levels of immunoglobulin IgM content in group I was more obvious than that in groupⅡ (t=2.163, P<0.05). The T cell subsets were lower than those before operation, the decrease of CD4⁺ in groupⅠwas more obvious than that in group Ⅱ (t=4.075, P<0.05). The levels of four kinds of visceral proteins were significantly lower than those before operation, and the level of TRF in group I was lower than that in groupⅠ (t=5.547, 2.357; all P<0.05); on the seventh day after operation, the four visceral proteins in group I increased compared with the third day after operation, and the contents of PRE and TRF in groupⅡwere not significantly different from those before operation (t=1.625, 0.816; all P>0.05).

Conclusion

Laparoscopic surgery in elderly patients with colorectal cancer under the concept of ERAS accelerated the recovery process of elderly patients, reduced the damage of surgical trauma to the body′s immune function, and reduced the nutritional loss.

Key words: Colorectal neoplasms, Laparoscopes, Enhanced recovery after surgery, Aged, Stress and immune function, Nutritional status

Honghui Chi, Zhigang Qiu, Junhui Wei, Yun Lu, Zhenqing Sun. The value of laparoscopy in the elderly colorectal fast track surgery[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2019, 08(02): 145-149.

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References 16

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临床资料		Ⅰ组	Ⅱ组	χ²/t值	P值
年龄（岁）		70.1±5.4	69.8±4.9	0.206	0.838
性别（男/女）		?	?	0	1.0
?	男	10	10	?	?
?	女	15	15	?	?
BMI（kg/m²）		23.2±2.1	22.9±1.9	0.530	0.599
手术部位		?	?	0.081	0.777
?	右半结肠	5	5	?	?
?	横结肠	1	0	?	?
?	左半结肠	3	2	?	?
?	乙状结肠	5	6	?	?
?	中高位直肠	11	12	?	?
TNM分期		?	?	0.335	0.846
?	Ⅰ期	6	5	?	?
?	Ⅱ期	14	16	?	?
?	Ⅲ期	5	4	?	?
ASA评分		?	?	0.120	0.989
?	Ⅰ级	5	5	?	?
?	Ⅱ级	12	11	?	?
?	Ⅲ级	6	7	?	?
?	Ⅳ级	2	2	?	?

临床资料		Ⅰ组	Ⅱ组	χ²/t值	P值
年龄（岁）		70.1±5.4	69.8±4.9	0.206	0.838
性别（男/女）		?	?	0	1.0
?	男	10	10	?	?
?	女	15	15	?	?
BMI（kg/m²）		23.2±2.1	22.9±1.9	0.530	0.599
手术部位		?	?	0.081	0.777
?	右半结肠	5	5	?	?
?	横结肠	1	0	?	?
?	左半结肠	3	2	?	?
?	乙状结肠	5	6	?	?
?	中高位直肠	11	12	?	?
TNM分期		?	?	0.335	0.846
?	Ⅰ期	6	5	?	?
?	Ⅱ期	14	16	?	?
?	Ⅲ期	5	4	?	?
ASA评分		?	?	0.120	0.989
?	Ⅰ级	5	5	?	?
?	Ⅱ级	12	11	?	?
?	Ⅲ级	6	7	?	?
?	Ⅳ级	2	2	?	?

?	术后肠道通气时间（d）	耐受半流质饮食时间（d）	术后住院时间（d）	并发症（例，%）
Ⅰ组	3.1±1.2	3.2±0.9	5.2±1.3	4（16%）
Ⅱ组	2.3±1.1	2.6±1.1	5.1±1.7	3（12%）
χ²/t值	2.457	2.111	0.234	0.166
P值	0.018	0.040	0.816	0.684

?	术后肠道通气时间（d）	耐受半流质饮食时间（d）	术后住院时间（d）	并发症（例，%）
Ⅰ组	3.1±1.2	3.2±0.9	5.2±1.3	4（16%）
Ⅱ组	2.3±1.1	2.6±1.1	5.1±1.7	3（12%）
χ²/t值	2.457	2.111	0.234	0.166
P值	0.018	0.040	0.816	0.684

检测指标		Ⅰ组	Ⅱ组	t值	P值
CRP（mg/L）		?	?	?	?
?	术前	1.3±0.7	1.1±0.7	1.010	0.317
?	术后3天	71.4±28.7^#	42.2±20.6^#	4.133	<0.001
?	术后7天	18.3±7.2^#	11.3±5.3^#	3.915	<0.001
IL-6（ng/L）		?	?	?	?
?	术前	8.1±2.6	8.2±2.7	0.133	0.894
?	术后3天	18.7±6.4^#	15.2±5.1^#	2.138	0.038
?	术后7天	13.1±2.1^#	9.8±2.3^#	5.298	<0.001
IgA（U/mL）		?	?	?	?
?	术前	156.9±46.6	158.4±48.6	0.111	0.912
?	术后3天	143.3±43.1^#	144.1±42.2^#	0.066	0.948
?	术后7天	152.7±34.9^#	155.9±49.5	0.264	0.793
IgG（U/mL）		?	?	?	?
?	术前	136.9±36.5	137.6±37.5	0.067	0.947
?	术后3天	123.4±40.1^#	122.3±41.8^#	0.095	0.925
?	术后7天	136.2±36.6	137.1±33.8	0.090	0.928
IgM（U/mL）		?	?	?	?
?	术前	172.7±50.2	173.5±49.6	0.057	0.955
?	术后3天	139.1±37.2^#	165.1±47.2^#	2.163	0.036
?	术后7天	165.1±46.4^#	172.4±45.5	0.562	0.577
CD4＋（%）		?	?	?	?
?	术前	30.9±3.16	30.15±3.21	0.832	0.410
?	术后3天	22.14±3.41^#	26.53±4.17^#	4.075	0.001
?	术后7天	31.1±3.13	30.11±3.23	1.101	0.276
CD8＋（%）		?	?	?	?
?	术前	27.52±3.61	27.36±2.12	0.191	0.849
?	术后3天	25.19±3.13^#	25.98±3.19^#	0.884	0.381
?	术后7天	27.19±3.41	27.41±3.32	0.231	0.818
CD3＋（%）		?	?	?	?
?	术前	55.94±8.14	56.11±7.13	0.079	0.937
?	术后3天	51.21±7.01^#	51.41±6.96^#	0.101	0.920
?	术后7天	55.89±7.23	55.96±7.31	0.034	0.973
ALB （g/L）		?	?	?	?
?	术前	35.8±2.8	35.9±3.1	0.120	0.905
?	术后3天	29.9±2.9^#	31.1±3.5^#	1.320	0.193
?	术后7天	31.8±2.6^#	33.5±3.1^#	2.101	0.041
PRE（mg/L）		?	?	?	?
?	术前	218±28	225±26	0.916	0.364
?	术后3天	168±29^#	170±25^#	0.261	0.795
?	术后7天	201±24^#	227±26	3.674	0.001
TRF（g/L）		?	?	?	?
?	术前	2.0±0.5	1.9±0.4	0.781	0.439
?	术后3天	1.1±0.2^#	1.5±0.3^#	5.547	<0.001
?	术后7天	1.7±0.3^#	1.9±0.3	2.357	0.023
RBP（mg/L）		?	?	?	?
?	术前	29.9±8.2	30.2±7.9	0.132	0.896
?	术后3天	23.3±3.1^#	23.1±3.9^#	0.201	0.842
?	术后7天	26.1±2.9^#	27.7±2.6^#	2.054	0.045

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