ObjectiveTo explore risk factors of gastric paralysis following gastrectomy of gastric cancer and analyze its causes. MethodsThe clinical data of 116 patients with gastric cancer for hospitalization time more than 21 days following gastrectomy were retrospectively analyzed from October 2011 to October 2013 in this hospital, in which 16 patients with gastric paralysis and 116 patients without gastric paralysis. The factors relevant gastric paralysis were analyzed by logistic regression analysis. ResultsThe results of single factor analysis showed that the preoperative body mass index, history of diabetes, operative time, postoperative cardiovascular complications, albumin and hemoglobin levels within 3 d after operation, time to get out of bed after surgery, extubation time of gastric tube, the first drinking time and the first feeding time were associated with the gastric paralysis (P < 0.05), but the gender, age, time of diabetes history, life mode, smoking history, hypertension history, pylorus preserving or not, laparoscopy or not, intraoperative blood loss, intraoperative blood transfusion, uses of postoperative intraperitoneal chemotherapy drugs and postoperative analgesic drugs, and indwelling time of jejunum nutrition tube were not associated with gastric paralysis (P > 0.05). The results of logistic regression analysis showed that the preoperative body mass index, history of diabetes, operative time, time to get out of bed after surgery, and postoperative cardiovascular complications were the independent risk factors of gastric paralysis (P < 0.05). ConclusionsThere are many factors that affect occurrence of gastric paralysis following gastrectomy of gastric cancer. Preoperative or intraoperative positive prevention measures could be taken according to the factors that might affect occurrence of gastric paralysis, which might be reduce gastric paralysis following gastrectomy of gastric cancer.
Objective To investigate the learning curve of laparoscopic assisted rectal cancer radical resection of a surgeon and share the experience of laparoscopic surgery. Methods The date of 119 consecutive patients who were suffered operation by same team during January 2010 to December 2015 were retrospectively analyzed. The learning curve and its stages were obtained by using weighted moving average method, cumulative sum analysis(CUSUM), risk-adjusted CUSUM (RA-CUSUM)and Matlab software. The effects of each stage, such as operative time, intraoperative bold loss, harvested lymph node numbers, distal margin to the edge of tumor, complications after operation, hospital stay days, and the first time take soft food were compared, and the experience of laparoscopic assisted surgery for rectal cancer was summarized. Results Our learning curve was divided into three periods, the cutting point was around 36th and 80th cases, respectively. There was no significant difference between the 3 stages in general data, however when comparing the operative time, loss of blood, harvested lymph node numbers, the distal margin to the edge of tumor, hospital stay and total complications, the last period were best and the first stage were worst. Conclusions The learning curve can be divided into three stages, the exploration, mastery and proficient period. Our term, fixed and with rich experience in laparotomy, completed our first exploration period at about 36th patients and the second stage is around 80th cases. And the short term effect of each period’s had gradually improved with master of laparoscopic technique.