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Objective To summarize the treatment experiences in gastrointestinal leaJcage atter gastrectomy for gastric cancer. Mehods From January 1997 to December 2006 the clinical data of 37 cases of gastrointestinal leakage including anastomotic leakage in 19 cases and duodenal stump leakage in 18 after gastrectomy for gastric cancer in People's Liberation Army General Hospital were analyzed retrospectively. Results All of the Cases were treated with abdominal drainage,continuous gastrointinal decomnression and parenteral nutrition combined with enteral nutrition.There were 32 cases receiving glutamine enrichment nutrition support,31 ases used somatostatin,13 cases received supplemented recombinarlt human growth hormone.Fistula healed in 21～30 d in 9 cases after gastrectomy,in the other 24 cases fistula healed in 30-60 d,while it healed in 60～81 d in the remaining 2 cases.Two died of leakage associated complications after gastrectomy for gastric cancer including anastomotlc leakage follwing esophagojejunostomy complicated by severe thoracic and lung infection in one and duodenal stump leakage complicated by severe abdominal cavity sepsis and hemorrhage in the other. Conclusion Patent and effective abdominal cavity drainage,continuous gastrointestinal decompression,parenteral nutrition combined with enteral nutrition,glutarnine,somatostafin and recombinant human growth hormone are the'mportant factors for the healing of gastrointestinal leakage after gastrectomy tor gastric cancer.
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Objective To evaluate the clinical effectiveness of perioperative fast-track surgery(FTS)program and nutrition support in the elderly patients with gastric cancer.Methods Totally 42 patients were equally randomized into FTS group(receiving perioperative FTS program)and control group(receiving a conventional therapy).The postoperative first defecation time,postoperative hospital stay,hospitahzation expenditure,and postoperative complications were compared between these two groups.Results The postoperative first defecation time and postoperative hospital stay were(75.4±24.3)hours and(11.2±3.2)days in FIS group and(98.0±22.6)hours and(14.4±4.6)days in control group(P=0.0165,P=0.0004;respectively).The hospitalization expenditure was significantly lower in FTS group than in control group[(3.66±0.48)×104 vs.(4.56±0.78)×104 RMB yuan;P=0.0001].The incidence of postoperative complications in FTS group was also significantly lower than that in control group(9.5% vs.28.6%,P=0.0422).Conclusion Perioperative FTS program can accelerate postoperative rehabilitation,shorten hospital stay,lower hospitalization expenditure,and reduce the incidence of postoperative complications.
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ObjectiveTo investigate the current situation of postoperative fluid therapy in general surgery department of grade Ⅲ-A general hospitals in Beijing and Tianjin. Methods Postoperative patients in general surgery department who were fasting for 3 days were retrospectively investigated, and 600 cases were recruited without considering age, gender, denomination of disease and operation type.The general information of patients, laboratory examination before and after operation, postoperative fluid therapy for 3 days, postoperative complications and infusion reaction were collected.Results In total 588 valid cases, the volume of average fluids supplement was (3030±638)ml per day, With the prescribed glucose (142+67)g per day, potassium chloride (59.9±23.9) mmol per day and sodium chloride (179.5±66.7) mmol per day. 85.2 % of total patients received nutrition support and the ratio of parenteral nutrition/enteral nutrition (PN/EN) was 28/1.There were 549 patients with BMI>18.5 before operation, and among them, 470 cases (85.6%)received parenteral and enteral nutrition treatment. There were 39 patients with BMI < 18.5 and 27 cases (69.2%) received parenteral nutrition support without enteral nutrition treatment. During the 3 days after operation, there were 36 cases with fluid therapy without potassium chloride supplement.ConclusionsThe proportions of receiving nutrition support and parenteral nutrition treatment are relatively high in grade Ⅲ-A general hospitals in Beijing and Tianjin. Ready-to-use preparation canreduce mistake and will be benefit to patients.