Rapid Rehabilitation Surgery Program In Perioperative Management Of Radical Cystectomy And Ileal Conduit Diversion

Background: To evaluate the clinical effect of rapid rehabilitation surgery in the perioperative period of radical resection of bladder cancer by using the comparison with traditional perioperative treatment scheme. MethodsIn this study, 80 patients who underwent bladder cancer with bladder cancer from August 2010 to October 2017 were collected, and the rapid rehabilitation Surgical treatment program and traditional treatment plan were adopted respectively during perioperative period, and the hospitalization cost, first exhaust time and after operation were compared between the two groups of patients. Clinical indexes such as hospitalization time and the incidence of postoperative complications to evaluate the application of both in the perioperative period of the radical ileum bladder surgery for bladder cancer. ResultsBoth groups of patients were cured and discharged. Compared with the traditional control group, the first exhaust time of the patients in the rapid recovery group was significantly earlier (3.10±0.45 D vs 3.88±0.91d P<0.05), the hospitalization cost (4.80±0.56 million vs 5.62±0.76 million P<0.05), and the length of hospital stay (8.8 6±1.23 d vs 14.47±3.58d P<0.05). However, there was no significant difference in the number of complications between the two groups (6 vs P>0.05). ConclusionsIt is safe and effective to have rapid rehabilitation surgery for the perioperative period of radical resection of bladder cancer, and the rapid rehabilitation Surgical treatment program has the advantage of shortening the length of hospital stay and reducing the cost of hospitalization compared with the traditional treatment plan, which is beneficial to the recovery of patients after operation.


Background
Rapid rehabilitation Surgery is a new concept in recent years, which refers to the application of various proven and effective methods before, during and after operation to reduce surgical stress and complications and accelerate postoperative rehabilitation of patients. He is a combination of effective measures that have produced synergies, many of which have been used in clinical applications such as perioperative nutritional support, attention to oxygen supply, early feeding, application of growth hormone, minimally invasive surgery, and so on. It includes several important elements: 1 preoperative patient education; 2 better anesthesia, pain relief and surgical techniques to reduce 3 surgical stress response, pain and discomfort; and 3 intensive postoperative rehabilitation treatment, including early bed activity and early bowel internal nutrition. At present, rapid rehabilitation surgical treatment program in general surgery, orthopaedic, gynecology and other successful applications, in urology is not yet common.

Subjects of study
In this group, 80 patients with bladder cancer radical ileum bladder surgery, all from the second affiliated Hospital of Hainan Medical College urology, preoperative pathological diagnosis are confirmed as high-grade bladder urinary tract skin cancer, tumor invasion of the inherent layer or muscle layer. After admission, all patients were divided into two groups according to the random number table, of which 42 cases (group A) and 38 cases (group B) were treated in the rapid rehabilitation group. The first exhaust time, hospitalization time, hospitalization cost and postoperative complications of the two groups were observed and compared. There were no urethral and distant metastasis in the two groups, no serious organ dysfunction such as diabetes mellitus and heart disease. There was no statistically significant difference in sex, age composition and the comparison of the combined diseases between the two groups (P>0.05), and all surgical operations and perioperative management were performed by the same group of physicians. written informed consent letter.

After postoperative feeding
Group A actively prevent postoperative nausea and vomiting symptoms, such as the use of gastric complex 10mg intra-muscular injection interval 8 hours 1 times, while encouraging patients to early oral feeding after the 1th day of the daily chewing sugar-containing sugar-free chewing gum, each 0.5h. On the 2nd day after operation, the patient ate slag free flow (200ml,q8h), the 3rd day after surgery, according to the need to eat fluid, the 4th day after surgery to restore the regular diet.
Patients in group B were treated with routine postoperative treatment without special treatment.
After awaiting exhaustion , gradually restore drinking water, and ensure enteric feeding.
All patients underwent radical resection of bladder cancer, and the ileum was used as the output channel for urinary flow diversions. Iodine volts were used to clean the intestine during the operation, and gastric fistula was performed in all patients. All patients ' surgeries were performed by two experienced urology surgeons. All patients underwent the same intraoperative and postoperative routine treatment. The first exhaust time, length of stay, hospitalization expenses and postoperative complications were recorded by the doctor after the operation.

Statistical analysis
Statistical analysis using SPSS23.0 software, data comparison using T test, to P<0.05 for the difference is significant.

Results
In the rapid rehabilitation group, 42 cases and 38 cases in the traditional group were operated smoothly and died without perioperative period. The rapid recovery group was superior to the   Compared to the traditional three-day intestinal preparation and oral magnesium sulfate method, it is planned to achieve a day of intestinal preparation and oral sodium phosphate solution, thereby reducing preoperative discomfort or pain. Randomized controlled trials with no bowel preparation and intestinal preparation before surgery were also conducted, arguing that preoperative intestinal preparation was not beneficial to patients, further shortening preoperative preparation time and reducing preoperative discomfort or pain. Early oral feeding is the most important part of rapid rehabilitation program. The traditional concept is that patients with total bladder cutting will have to wait until the anus exhaust to eat, the general postoperative 2-3d can not enter the liquid diet. And the concept of rapid rehabilitation surgery [6] believes that bowel sound recovery should not be used as a criterion for restoring eating. Studies have shown that [7][8], early oral feeding will not only not increase the risk of intestinal anastomotic fistula, but also can stimulate intestinal motor function through hormonal nerve reflex, relieve postoperative abdominal distension and promote the recovery of intestinal function. In addition to 3 cases of nausea and vomiting, the rest of the patients in the rapid recovery group were treated with early imported feeding programmes. On the first day after surgery, we drew on the research results of Rogers RC and other [9], and instructed patients to chew gum 2h after anesthesia, to stimulate

Conclusions 9
Compared with the traditional method, the rapid rehabilitation program has the protection and promotion effect to the organ function, its advantage has the early bed activity, can better preserve the lean meat group, reduces the postoperative lung function damage, restores the gastrointestinal peristalsis function early, increases the activity ability, enhances the cardiovascular function. The rapid rehabilitation programme has also increased patient satisfaction while reducing the cost of treatment. One concept that needs to be highlighted is that rapid rehabilitation surgery is primarily designed to control the pathophysiological response during the perioperative period, with the aim of promoting the rehabilitation of patients, rather than simply for early discharge. Its significance lies not only in reducing the cost of treatment, but also, and more importantly, in improving better and more effective medical services. Although these methods can reduce costs, their main aim is to improve surgical treatment by reducing complications and improving a better prognosis. In a word, the basic concept of rapid rehabilitation program is to control the pathophysiological changes during perioperative period by multi-mode, and to improve the prognosis of surgical patients.

Ethical approval and consent to participate
Ethical approval was obtained from Institutional Review Board of the Second Affiliated Hospital of

Consent for publication
Not applicable.

Availability of data and material
We declared that materials described in the manuscript,including all relevant raw data,will be freely available to any scientist wishing to use them for non-commercial purposes,without breaching participant confidentiality.

Competing interests
The authors declare that they have no competing interests.

Funding
The study was supported by scientific research project of hainan health and family planning industry