ObjectiveTo compare the short-term efficacy of laparoscopic transanal pull through surgery and conventional laparoscopic surgery for rectal cancer.MethodsRelevant literatures were retrieved from databases including PubMed, Cochrane Library databases, Embase, CNKI, CBM, Wan-fang database, and VIP databases from Jan. 2009 to Jul. 2019, all the relevant trial documents ［included randomized controlled trial and non randomized controlled trial］ were collected for comparison of laparoscopic transanal pull through surgery and conventional laparoscopic surgery on the clinical efficacy of rectal cancer patients, the qualified literatures were screened in strict accordance with inclusion and exclusion criteria, and Stata12.0 software was used for statistical analysis.ResultsA total of 19 articles were included in the literature with 2 683 patients were included among them. Meta analysis results showed that, compared with the conventional laparoscopic surgery group, in laparoscopic transanal pull through surgery group, operation time [WMD=–6.78, 95% CI was (–11.96, –1.60), P<0.01], intraoperative blood loss [WMD=–14.94, 95% CI was (–23.48, –6.40),P<0.01], postoperative exhaust time [WMD=–13.55, 95% CI was (–18.24, –8.85), P<0.01], postoperative hospitalization time [WMD=–1.60, 95% CI was (–2.00, –1.21), P<0.01], incidence of postoperative overall complication [OR=0.50, 95% CI was (0.38, 0.67), P<0.01], and incidence of incision infection [OR=0.19, 95% CI was (0.08, 0.45), P<0.01] reduced. Those differences were not significant, such as intraoperative lymph node resection [WMD=–0.02, 95% CI was (–0.44, 0.40), P=0.92], incision margin distance of tumor [WMD=0.13, 95% CI was (–0.30, 0.55), P=0.56], and incidence of anastomotic fistula [OR=0.97, 95% CI was (0.62, 1.50), P=0.87].ConclusionsLaparoscopic transanal pull through surgery has more safe, effective, and reliable effects than conventional laparoscopic surgery for rectal cancer. It has further research value, but there may be inevitable bias and other effects in the included literatures, so more randomized controlled clinical trials are needed in the future.
The anesthetic work of day surgery should be guided by the standardized perioperative evaluation system. The evaluation methods and standards with strong operability and repeatability are the prerequisites to ensure the safety and efficiency of day surgery. For the assessment of patients’ preoperative physiological status, preoperative preparation and postoperative rehabilitation, standardized work procedures should be established to ensure patients’ medical safety to the greatest extent. Through summarizing the advanced management experience of day surgery anesthesia at home and abroad, and combining with the principled suggestions in The Consensus of Chinese Experts on Anaesthesia for Day Surgery, the First Affiliated Hospital of Dalian Medical University has repeatedly revised the perioperative anesthesia evaluation methods in practice, and gradually explored a comprehensive, rigorous and standardized perioperative anesthesia evaluation system. This paper will focus on the evaluation of perioperative anesthesia and postoperative follow-up procedures in day surgery.
Day surgery dates back to 1909, when it was first performed by British paediatricians. Anesthesia management for day surgery requires quick onset, early recovery, rapid recovery, and few perioperative adverse reactions. Ensuring the medical safety of patients is the primary condition for the gradual implementation of day surgery. With the continuous development of medical level, the applicable field of day surgery has gradually expanded, and new concepts and progress have also emerged in anesthesia management. This article summarizes the relevant research at home and abroad, and reviews the new progress of anesthesia for day surgery from three aspects: preparation before anesthesia, selection of anesthesia methods, and recovery after anesthesia, in order to provide a reference for anesthesia management of day surgery.
Enhanced recovery after surgery (ERAS) is a protocol designed to improve perioperative outcomes by multidisciplinary team with evidence-based interventions. The implementation of ERAS concept has been proved to reduce postoperative complications and hospital stay. The anesthesia management under the concept of ERAS is the basis of safe and smooth ambulatory surgical protocol. This article summarizes the latest clinical evidence at home and abroad, and reviews the preoperative optimization, anesthesia mode selection, ventilation strategies, fluid management, temperature support, pain management, postoperative nausea and vomiting prevention, postoperative nutritional support, and postoperative sleep improvement in the management of anesthesia under ERAS concept, in order to provide a reference for anesthesia management in ambulatory surgery.