Almost all patients develop postoperative ileus (POI) after abdominal surgery.POI represents the single largest factor influencing length of stay (LOS) after bowel resection,and has great implications for patients and...Almost all patients develop postoperative ileus (POI) after abdominal surgery.POI represents the single largest factor influencing length of stay (LOS) after bowel resection,and has great implications for patients and resource utilization in health care.New methods to treat and decrease the length of POI are therefore of great importance.During the past decade,a substantial amount of research has been performed evaluating POI,and great progress has been made in our understanding and treatment of POI.Laparoscopic procedures,enhanced recovery pathways and pharmacologic treatment have been introduced.Each factor has substantially contributed to decreasing the length of POI and thus LOS after bowel resection.This editorial outlines resource utilization of POI,normal physiology of gut motility and pathogenesis of POI.Pharmacological treatment,fast track protocols and laparoscopic surgery can each have significant impact on pathways causing POI.The optimal integration of these treatment options continues to be assessed in prospective studies.展开更多
目的比较腹腔镜与开腹手术治疗胃癌术后肠梗阻的发生率。方法通过Pub Med、EMBASE、OVID、Medline、中国期刊全文数据库、万方数据发表的有关腹腔镜与传统开腹胃癌根治术后发生肠梗阻相关随机对照研究文献进行定量分析,检索时间从建库至...目的比较腹腔镜与开腹手术治疗胃癌术后肠梗阻的发生率。方法通过Pub Med、EMBASE、OVID、Medline、中国期刊全文数据库、万方数据发表的有关腹腔镜与传统开腹胃癌根治术后发生肠梗阻相关随机对照研究文献进行定量分析,检索时间从建库至2014年3月止,采用Re Man 5.1软件对数据进行Meta分析。结果按入选纳入标准,共14篇文献纳入研究,总样本量3997例,其中腹腔镜组2196例,术后发生肠梗阻18例,开腹组1801例,术后发生肠梗阻46例,合并RR=0.37,95%CI：0.23~0.62,提示腹腔镜组术后肠梗阻的发生率为开腹组的37%,差异有统计学意义（P〈0.01）。结论相对于开腹胃癌手术,腹腔镜胃癌手术可以降低术后早期肠梗阻的发生率。展开更多
Postoperative ileus is a frequently occurring surgical complication, leading to increased morbidity and hospital stay. Abdominal surgical interventions are known to result in a protracted cessation of bowel movement. ...Postoperative ileus is a frequently occurring surgical complication, leading to increased morbidity and hospital stay. Abdominal surgical interventions are known to result in a protracted cessation of bowel movement. Activation of inhibitory neural pathways by nociceptive stimuli leads to an inhibition of propulsive activity, which resolves shortly after closure of the abdomen. The subsequent formation of an inflammatory infiltrate in the muscular layers of the intestine results in a more prolonged phase of ileus. Over the last decade, clinical strategies focusing on reduction of surgical stress and promoting postoperative recovery have improved the course of postoperative ileus. Additionally, recent experimental evidence implicated antiinflammatory interventions, such as vagal stimulation, as potential targets to treat postoperative ileus and reduce the period of intestinal hypomotility. Activation of nicotinic receptors on inflammatory cells by vagal input attenuates inflammation and promotes gastrointestinal motility in experimental models of ileus. A novel physiologicalintervention to activate this neuroimmune pathway is enteral administration of lipid-rich nutrition. Perioperative administration of lipid-rich nutrition reduced manipulation-induced local inflammation of the intestine and accelerated recovery of bowel movement. The application of safe and easy to use antiinflammatory interventions, together with the current multimodal approach, could reduce postoperative ileus to an absolute minimum and shorten hospital stay.展开更多
AIM To investigate the efficacy and safety of transcutaneouselectroacupuncture(TEA) to alleviate postoperative ileus(POI) after gastrectomy.METHODS From April 2014 to February 2017, 63 gastric cancer patients were rec...AIM To investigate the efficacy and safety of transcutaneouselectroacupuncture(TEA) to alleviate postoperative ileus(POI) after gastrectomy.METHODS From April 2014 to February 2017, 63 gastric cancer patients were recruited from the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China. After gastrectomy, the patients were randomly allocated to the TEA(n = 33) or control(n = 30) group. The patients in the TEA group received 1 h TEA on Neiguan(ST36) and Zusanli(PC6) twice daily in the morning and afternoon until they passed flatus. The main outcomes were hours to the first flatus or bowel movement, time to nasogastric tube removal, time to liquid and semi-liquid diet, and hospital stay. The secondary outcomes included postoperative symptom assessment and complications.RESULTS Time to first flatus in the TEA group was significantly shorter than in the control group(73.19 ± 15.61 vs 82.82 ± 20.25 h, P = 0.038), especially for open gastrectomy(76.53 ± 14.29 vs 87.23 ± 20.75 h, P = 0.048). Bowel sounds on day 2 in the TEA group were significantly greater than in the control group(2.30 ± 2.61/min vs 1.05 ± 1.26/min, P = 0.017). Time to nasogastric tube removal in the TEA group was earlier than in the control group(4.22 ± 1.01 vs 4.97 ± 1.67 d, P = 0.049), as well as the time to liquid diet(5.0 ± 1.34 vs 5.83 ± 2.10 d, P = 0.039). Hospital stay in the TEA group was significantly shorter than in the control group(8.06 ± 1.75 vs 9.40 ± 3.09 d, P = 0.041). No significant differences in postoperative symptom assessment and complications were found between the groups. There were no severe adverse events related to TEA.CONCLUSION TEA accelerated bowel movements and alleviated POI after open gastrectomy and shortened hospital stay.展开更多
基金Supported by North Norwegian Health Authorities Research Fund
文摘Almost all patients develop postoperative ileus (POI) after abdominal surgery.POI represents the single largest factor influencing length of stay (LOS) after bowel resection,and has great implications for patients and resource utilization in health care.New methods to treat and decrease the length of POI are therefore of great importance.During the past decade,a substantial amount of research has been performed evaluating POI,and great progress has been made in our understanding and treatment of POI.Laparoscopic procedures,enhanced recovery pathways and pharmacologic treatment have been introduced.Each factor has substantially contributed to decreasing the length of POI and thus LOS after bowel resection.This editorial outlines resource utilization of POI,normal physiology of gut motility and pathogenesis of POI.Pharmacological treatment,fast track protocols and laparoscopic surgery can each have significant impact on pathways causing POI.The optimal integration of these treatment options continues to be assessed in prospective studies.
文摘目的比较腹腔镜与开腹手术治疗胃癌术后肠梗阻的发生率。方法通过Pub Med、EMBASE、OVID、Medline、中国期刊全文数据库、万方数据发表的有关腹腔镜与传统开腹胃癌根治术后发生肠梗阻相关随机对照研究文献进行定量分析,检索时间从建库至2014年3月止,采用Re Man 5.1软件对数据进行Meta分析。结果按入选纳入标准,共14篇文献纳入研究,总样本量3997例,其中腹腔镜组2196例,术后发生肠梗阻18例,开腹组1801例,术后发生肠梗阻46例,合并RR=0.37,95%CI：0.23~0.62,提示腹腔镜组术后肠梗阻的发生率为开腹组的37%,差异有统计学意义（P〈0.01）。结论相对于开腹胃癌手术,腹腔镜胃癌手术可以降低术后早期肠梗阻的发生率。
基金Supported by DANONE Research Centre for Specialised Nutrition, Wageningen, the Netherlandsby AGIKO-stipendia 920-03-522 (to Lubbers T) and 920-03-271 (to Luyer M) from the Netherlands Organization for Health Research and Development
文摘Postoperative ileus is a frequently occurring surgical complication, leading to increased morbidity and hospital stay. Abdominal surgical interventions are known to result in a protracted cessation of bowel movement. Activation of inhibitory neural pathways by nociceptive stimuli leads to an inhibition of propulsive activity, which resolves shortly after closure of the abdomen. The subsequent formation of an inflammatory infiltrate in the muscular layers of the intestine results in a more prolonged phase of ileus. Over the last decade, clinical strategies focusing on reduction of surgical stress and promoting postoperative recovery have improved the course of postoperative ileus. Additionally, recent experimental evidence implicated antiinflammatory interventions, such as vagal stimulation, as potential targets to treat postoperative ileus and reduce the period of intestinal hypomotility. Activation of nicotinic receptors on inflammatory cells by vagal input attenuates inflammation and promotes gastrointestinal motility in experimental models of ileus. A novel physiologicalintervention to activate this neuroimmune pathway is enteral administration of lipid-rich nutrition. Perioperative administration of lipid-rich nutrition reduced manipulation-induced local inflammation of the intestine and accelerated recovery of bowel movement. The application of safe and easy to use antiinflammatory interventions, together with the current multimodal approach, could reduce postoperative ileus to an absolute minimum and shorten hospital stay.
基金Supported by Zhejiang Provincial Chinese Medicine Scientific Research Fund,No.2017ZA085
文摘AIM To investigate the efficacy and safety of transcutaneouselectroacupuncture(TEA) to alleviate postoperative ileus(POI) after gastrectomy.METHODS From April 2014 to February 2017, 63 gastric cancer patients were recruited from the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China. After gastrectomy, the patients were randomly allocated to the TEA(n = 33) or control(n = 30) group. The patients in the TEA group received 1 h TEA on Neiguan(ST36) and Zusanli(PC6) twice daily in the morning and afternoon until they passed flatus. The main outcomes were hours to the first flatus or bowel movement, time to nasogastric tube removal, time to liquid and semi-liquid diet, and hospital stay. The secondary outcomes included postoperative symptom assessment and complications.RESULTS Time to first flatus in the TEA group was significantly shorter than in the control group(73.19 ± 15.61 vs 82.82 ± 20.25 h, P = 0.038), especially for open gastrectomy(76.53 ± 14.29 vs 87.23 ± 20.75 h, P = 0.048). Bowel sounds on day 2 in the TEA group were significantly greater than in the control group(2.30 ± 2.61/min vs 1.05 ± 1.26/min, P = 0.017). Time to nasogastric tube removal in the TEA group was earlier than in the control group(4.22 ± 1.01 vs 4.97 ± 1.67 d, P = 0.049), as well as the time to liquid diet(5.0 ± 1.34 vs 5.83 ± 2.10 d, P = 0.039). Hospital stay in the TEA group was significantly shorter than in the control group(8.06 ± 1.75 vs 9.40 ± 3.09 d, P = 0.041). No significant differences in postoperative symptom assessment and complications were found between the groups. There were no severe adverse events related to TEA.CONCLUSION TEA accelerated bowel movements and alleviated POI after open gastrectomy and shortened hospital stay.
