Research on Postoperative Stress Response after the Application of Fast Track Surgery in Hepatobiliary Surgery_West China Medical Journal

Authors：

 LIUJun ,  NIPing-zhi , TANGKe-li , WANGJun , CHENGJian-hua , LUODan , HUANGJian-zhao

Department of Hepatobiliary and Pancreatic Surgery, Guizhou Provincial People's Hospital, Guiyang, Guizhou 550002, P. R. China;

Corresponding author：

NIPing-zhi, Email: nipingzhi1963@126.com

Keywords：

Fast track surgery; C-reaction protein; Interleukin-6

DOI：

10.7507/1002-0179.20150577

Video：

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Objective To investigate the application of fast track surgery (FTS) in hepatobiliary surgery, and discuss the postoperative stress response and its efficacy and safety assessment. Methods A 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. Results For 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). Conclusion The application of FTS in some hepatobiliary operations is effective and safe by decreasing the stress response.

Citation： LIUJun, NIPing-zhi, TANGKe-li, WANGJun, CHENGJian-hua, LUODan, HUANGJian-zhao. Research on Postoperative Stress Response after the Application of Fast Track Surgery in Hepatobiliary Surgery. West China Medical Journal, 2015, 30(11): 2023-2026. doi: 10.7507/1002-0179.20150577 Copy

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2.	Wu SJ, Xiong XZ, Lu J, et al. Fast-Track programs for liver surgery:a Meta-Analysis[J]. J Gastrointest Surg, 2015, 19(9):1640-1652.
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7.	江志伟, 黎介寿, 汪志明, 等. 胃癌患者应用加速康复外科治疗的安全性及有效性研究[J]. 中华外科杂志, 2007, 45(19):1314-1317.
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10.	Brandstrup B. Fluid therapy for the surgical patient[J]. Best Pract Res Clin Anaesthesiol, 2006, 20(2):265-283.
11.	黎介寿. 对Fast-track Surgery(快通道外科)内涵的认识[J]. 中华医学杂志, 2007, 87(8):515-517.
12.	Lewis SJ, Egger M, Sylvester PA, et al. Early enteral feeding versus “nil by mouth” after gastrointestinal surgery:systematic review and meta-analysis of controlled trials[J]. BMJ, 2001, 323(7316):773-776.
13.	Reismann M, Von Kampen M, Laupichler B, et al. Fast-track surgery in infants and children[J]. J Pediatr Surg, 2007, 42(1):234-238.
14.	Bonde C, Khorasani H, Eriksen K, et al. Introducing the fast track surgery principles can reduce length of stay after autologous breast reconstruction using free flaps:a case control study[J]. J Plast Surg Hand Surg, 2015(10):1-5.
15.	Kianfar AA, Ahmadi ZH, Mirhossein SM, et al. Ultra fast-track extubation in heart transplant surgery patients[J]. Int J Crit Illn Inj Sci, 2015, 5(2):89-92.
16.	Wang JY, Hong X, Chen GH, et al. Clinical application of the fast track surgery model based on preoperative nutritional risk screening in patients with esophageal cancer[J]. Asia Pac J Clin Nutr, 2015, 24(2):206-211.
17.	Williamsson C, Karlsson N, Sturesson C, et al. Impact of a fast-track surgery programme for pancreaticoduodenectomy[J]. Br J Surg, 2015, 102(9):1133-1141.
18.	Philp S, Carter J, Pather S, et al. Patients’ satisfaction with fast-track surgery in gynaecological oncology[J]. Eur J Cancer Care (Engl), 2015, 24(4):567-573.

1. 江志伟, 李宁, 黎介寿. 快速康复外科的概念及临床意义[J]. 中国实用外科杂志, 2007, 27(2):131-133.
2. Wu SJ, Xiong XZ, Lu J, et al. Fast-Track programs for liver surgery:a Meta-Analysis[J]. J Gastrointest Surg, 2015, 19(9):1640-1652.
3. 姜洪池, 孙备, 王刚. 快速康复外科的新理念值得重视[J]. 中华外科杂志, 2007, 45(9):577-579.
4. Bu J, Li N, Huang X, et al. Feasibility of fast-track surgery in elderly patients with gastric cancer[J]. J Gastrointest Surg, 2015, 19(8):1391-1398.
5. Shao Z, Jin G, Ji W, et al. The role of fast-track surgery in pancreaticoduodenectomy:a retrospective cohort study of 635 consecutive resections[J]. Int J Surg, 2015, 15(15):129-133.
6. 杨东杰, 蔡世荣, 何裕隆, 等. 快速康复外科在结直肠癌择期手术中的应用效果[J]. 中华普通外科杂志, 2009, 24(6):477-479.
7. 江志伟, 黎介寿, 汪志明, 等. 胃癌患者应用加速康复外科治疗的安全性及有效性研究[J]. 中华外科杂志, 2007, 45(19):1314-1317.
8. Wilmore DW, Kehlet H. Managament of patients in fast track surgery[J]. BMJ, 2001, 322(7284):473-476.
9. Zausig YA, Weigand MA, Graf BM. Perioperative fluid management:an analysis of the present situation[J]. Anaesthesist, 2006, 55(4):371-390.
10. Brandstrup B. Fluid therapy for the surgical patient[J]. Best Pract Res Clin Anaesthesiol, 2006, 20(2):265-283.
11. 黎介寿. 对Fast-track Surgery(快通道外科)内涵的认识[J]. 中华医学杂志, 2007, 87(8):515-517.
12. Lewis SJ, Egger M, Sylvester PA, et al. Early enteral feeding versus “nil by mouth” after gastrointestinal surgery:systematic review and meta-analysis of controlled trials[J]. BMJ, 2001, 323(7316):773-776.
13. Reismann M, Von Kampen M, Laupichler B, et al. Fast-track surgery in infants and children[J]. J Pediatr Surg, 2007, 42(1):234-238.
14. Bonde C, Khorasani H, Eriksen K, et al. Introducing the fast track surgery principles can reduce length of stay after autologous breast reconstruction using free flaps:a case control study[J]. J Plast Surg Hand Surg, 2015(10):1-5.
15. Kianfar AA, Ahmadi ZH, Mirhossein SM, et al. Ultra fast-track extubation in heart transplant surgery patients[J]. Int J Crit Illn Inj Sci, 2015, 5(2):89-92.
16. Wang JY, Hong X, Chen GH, et al. Clinical application of the fast track surgery model based on preoperative nutritional risk screening in patients with esophageal cancer[J]. Asia Pac J Clin Nutr, 2015, 24(2):206-211.
17. Williamsson C, Karlsson N, Sturesson C, et al. Impact of a fast-track surgery programme for pancreaticoduodenectomy[J]. Br J Surg, 2015, 102(9):1133-1141.
18. Philp S, Carter J, Pather S, et al. Patients’ satisfaction with fast-track surgery in gynaecological oncology[J]. Eur J Cancer Care (Engl), 2015, 24(4):567-573.

West China Medical Journal

Research on Postoperative Stress Response after the Application of Fast Track Surgery in Hepatobiliary Surgery

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