胃肠道肿瘤患者术中联合腹腔热灌注化学治疗对术后胃肠功能恢复的影响因素分析
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摘要
目的·探讨胃肠道肿瘤患者术中联合腹腔热灌注化学治疗对术后胃肠功能恢复的影响。方法·收集2014年7月—2017年6月在上海市(复旦大学附属)公共卫生临床中心/复旦大学附属中山医院南院行细胞减灭术联合腹腔热灌注化学治疗的胃肠道肿瘤患者62例。根据I-FEED评分系统对患者的胃肠功能评分,将其分为胃肠功能恢复顺利组(I-FEED评分<6分,38例)和延迟恢复组(I-FEED评分≥6分,24例)。选择包括性别、年龄、是否合并糖尿病、术前白蛋白等可能对2组患者术后胃肠功能恢复有影响的特征性因素进行单因素分析和多因素Logistic分析。结果·胃肠功能恢复顺利组和延迟组患者在术前白蛋白水平(P=0.040)、术中出血量(P=0.044)、腹腔引流管拔除时间(P=0.026)、导尿管拔除时间(P=0.021)和住院时间(P=0.017)的相关指标上的差异均存在统计学意义。多因素Logistic回归结果提示术前白蛋白水平可能有利于术后胃肠功能顺利恢复(OR=0.84, 95%CI 0.17～4.27,P=0.041)。结论·对于行细胞减灭术联合腹腔热灌注化学治疗的胃肠道肿瘤患者,术前白蛋白可作为术后胃肠功能恢复障碍发生的独立预测因素。
Objective · To investigate the effect of hyperthermic intraperitoneal chemotherapy on postoperative gastrointestinal function recovery in patients with gastrointestinal cancer. Methods · Sixty-two cases of gastrointestinal cancer patients were enrolled who accepted cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in Department of General Surgery, Shanghai Public Health Clinical Center, Fudan University, from July 2014 to June 2017. The gastrointestinal function of patients were evaluated according to the I-FEED scoring system. The patients were divided into normal recovery group(I-FEED score<6, n=38) and delayed recovery group(I-FEED score ≥ 6, n=24). Univariate and multivariate Logistic analyses were performed on characteristic factors that may affect the recovery of postoperative gastrointestinal function including gender, age, presence of diabetes, preoperative albumin, and so on. Results · There were significantly differences in the preoperative serum albumin level(P=0.040), intraoperative bleeding(P=0.044),the time of extraction of the peritoneal cavity drainage tube(P=0.026), the time of urethral tube extraction(P=0.021) and the time of hospitalization(P=0.017) in the two groups of patients with normal or delayed gastrointestinal function recovery. Multivariate Logistic regression results suggested that preoperative serum albumin level may be beneficial for the recovery of postoperative gastrointestinal function(OR=0.84, 95% CI 0.17-4.27, P=0.041).Conclusion · The preoperative serum albumin level can be used as an independent predictor of postoperative gastrointestinal functional recovery in patients with gastrointestinal cancer after cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy.
Objective · To investigate the effect of hyperthermic intraperitoneal chemotherapy on postoperative gastrointestinal function recovery in patients with gastrointestinal cancer. Methods · Sixty-two cases of gastrointestinal cancer patients were enrolled who accepted cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in Department of General Surgery, Shanghai Public Health Clinical Center, Fudan University, from July 2014 to June 2017. The gastrointestinal function of patients were evaluated according to the I-FEED scoring system. The patients were divided into normal recovery group(I-FEED score<6, n=38) and delayed recovery group(I-FEED score ≥ 6, n=24). Univariate and multivariate Logistic analyses were performed on characteristic factors that may affect the recovery of postoperative gastrointestinal function including gender, age, presence of diabetes, preoperative albumin, and so on. Results · There were significantly differences in the preoperative serum albumin level(P=0.040), intraoperative bleeding(P=0.044),the time of extraction of the peritoneal cavity drainage tube(P=0.026), the time of urethral tube extraction(P=0.021) and the time of hospitalization(P=0.017) in the two groups of patients with normal or delayed gastrointestinal function recovery. Multivariate Logistic regression results suggested that preoperative serum albumin level may be beneficial for the recovery of postoperative gastrointestinal function(OR=0.84, 95% CI 0.17-4.27, P=0.041).Conclusion · The preoperative serum albumin level can be used as an independent predictor of postoperative gastrointestinal functional recovery in patients with gastrointestinal cancer after cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy.
引文
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[19]Pedziwiatr M,Mavrikis J,Witowski J,et al.Current status of enhanced recovery after surgery(ERAS)protocol in gastrointestinal surgery[J].Med Oncol,2018,35(6):95.
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[21]Mei B,Wang W,Cui F,et al.Chewing gum for intestinal function recovery after colorectal cancer surgery:a systematic review and meta-analysis[J].Gastroenterol Res Pract,2017,2017:3087904.
[22]Jankowski CJ.Preparing the patient for enhanced recovery after surgery[J].Int Anesthesiol Clin,2017,55(4):12-20.
[2]Wong YET,Tan GHC,Chia CSL,et al.Morbidity and mortality of elderly patients following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy(HIPEC)[J].Asia Pac J Clin Oncol,2018,14(2):e193-e202.
[3]Feldman LS,Lee L,Fiore J Jr,et al.What outcomes are important in the assessment of enhanced recovery after surgery(ERAS)pathways?[J].Can JAnaesth,2015,62(2):120-130.
[4]Votanopoulos KI,Bartlett D,Moran B,et al.PCI is not predictive of survival after complete CRS/HIPEC in peritoneal dissemination from high-grade appendiceal primaries[J].Ann Surg Oncol,2018,25(3):674-678.
[5]Pallas N,Karamveri C,Kyziridis D,et al.Cytoreductive surgery and hyperthermic intraperitenoal chemotherapy(HIPEC)for colorectal and appendiceal carcinomas with peritoneal carcinomatosis[J].J BUON,2017,22(6):1547-1553.
[6]Traci LH,Matthew DME,Michael GM,et al.American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on postoperative gastrointestinal dysfunction within an enhanced recovery pathway for elective colorectal surgery[J].Anesth Analg,2018,126(6):1896-1907.
[7]李雁,周云峰,梁寒,等.细胞减灭术加腹腔热灌注化疗治疗腹膜表面肿瘤的专家共识[J].中国肿瘤临床,2015,42(4):198-206.
[8]Newton AD,Bartlett EK,Karakousis GC,et al.Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy:a review of factors contributing to morbidity and mortality[J].J Gastrointest Oncol,2016,7(1):99-111.
[9]李雁,于洋,刘洋.第9届国际腹膜癌大会报道[J].中国肿瘤临床,2014,41(24):1561-1563.
[10]Sun DL,Li WM,Li SM,et al.Comparison of multi-modal early oral nutrition for the tolerance of oral nutrition with conventional care after major abdominal surgery:a prospective,randomized,single-blind trial[J].Nutr J,2017,16(1):11.
[11]葛晨.不同剂量生大黄鼻饲对胃肠肿瘤患者术后胃肠道功能及炎性反应、免疫功能影响的随机对照研究[D].合肥:安徽医科大学,2015.
[12]Brettner F,Janitza S,Prull K,et al.Gender-specific differences in low-dose haloperidol response for prevention of postoperative nausea and vomiting:a register-based cohort study[J].PLo S One,2016,11(1):e0146746.
[13]饶群.术后胃肠道功能紊乱的研究进展[J].中国危重病急救医学,2012,6(24):382-384.
[14]Gan H,Lin J,Jiang Z,et al.Xiangbin prescription for the recovery of gastrointestinal function after abdominal surgery(the XBPRS trial):study protocol for a randomized controlled trial[J].Trials,2018,19(1):146.
[15]van Bree SH,Bemelman WA,Hollmann MW,et al.Identification of clinical outcome measures for recovery of gastrointestinal motility in postoperative ileus[J].Ann Surg,2014,259(4):708-714.
[16]Ullah MA,Rahman MA,Chowdhury LH,et al.Outcome of upper gastrointestinal surgery with or without nasogastric intubation[J].Mymensingh Med J,2017,26(3):650-657.
[17]Nelson R,Edwards S,Tse B,et al.Prophylactic nasogastric decompression after abdominal surgery[J].Cochrane Database Syst Rev,2007(3):CD004929.
[18]Wallstrom A,Frisman GH.Facilitating early recovery of bowel motility after colorectal surgery:a systematic review[J].J Clin Nurs,2014,23(1/2):24-44.
[19]Pedziwiatr M,Mavrikis J,Witowski J,et al.Current status of enhanced recovery after surgery(ERAS)protocol in gastrointestinal surgery[J].Med Oncol,2018,35(6):95.
[20]Makaryus R,Miller TE,Gan TJ.Current concepts of fluid management in enhanced recovery pathways[J].Br J Anaesth,2018,120(2):376-383.
[21]Mei B,Wang W,Cui F,et al.Chewing gum for intestinal function recovery after colorectal cancer surgery:a systematic review and meta-analysis[J].Gastroenterol Res Pract,2017,2017:3087904.
[22]Jankowski CJ.Preparing the patient for enhanced recovery after surgery[J].Int Anesthesiol Clin,2017,55(4):12-20.