Improvement of inflammatory response and gastrointestinal function in perioperative of cholelithiasis by Modified Xiao-Cheng-Qi decoction

Table 1 All ingredients of the different treatment group

Group	Ingredient
Control	Warm boiled water
XD	Dahuang (Rhubarb) 6 g, Houbu (Magnolia officinalis) 6 g and Zhishi (Immature Bitter Orange) 12 g
MXD	Dahuang (Rhubarb) 6 g, Houbu (Magnolia officinalis) 6 g, Zhishi (Immature Bitter Orange) 12 g, Huangqi (Astragalus) 20 g, Ruxiang (Frankincense) 6 g and Moyao (Myrrh) 6 g

XD: Xiao-Cheng-Qi decoction; MXD: Modified Xiao-Cheng-Qi decoction.

Table 2 Basic characteristics of the participants

Characteristics/group	Control (n = 53)	XD (n = 54)	MXD (n = 55)	P value
Age (yr)	57.19 ± 13.19	55.44 ± 15.75	54.53 ± 15.36	0.640
Sex				0.782
Male	23 (43.4%)	26 (48.1%)	24 (43.6%)
Female	30 (56.6%)	28 (51.9%)	31 (56.4%)
BMI (kg/m2)	23.84 ± 1.85	23.78 ± 2.01	24.06 ± 1.64	0.701
Concomitant disease				0.917
Yes	30 (56.6%)	28 (51.9%)	29 (52.7%)
No	23 (43.4%)	26 (48.1%)	26 (47.3%)
Operation mode				0.997
Laparoscopic cholecystectomy	45 (84.9%)	46 (85.2%)	47 (85.5%)
Laparoscopic cholecystectomy and choledocholithotomy	8 (15.1%)	8 (14.85%)	8 (14.5%)
Operation time (min)	176.70 ± 47.02	178.89 ± 47.13	173.09 ± 49.36	0.816
Intraoperative blood loss (mL)	37.36 ± 22.80	37.04 ± 19.97	36.36 ± 19.94	0.969

XD: Xiao-Cheng-Qi decoction; MX: Modified Xiao-Cheng-Qi decoction; BMI: Body mass index.

Table 3 Recovery of gastrointestinal function after biliary surgery

Parameters	Control (n = 53)	XD (n = 54)	MXD (n = 55)	P value
Bowel sounds (times/min)
2 h before surgery	4.66 ± 0.68	4.39 ± 0.86	4.42 ± 0.79	0.144
0 h after surgery	0.02 ± 0.141	0.06 ± 0.231	0.15 ± 0.361,2	0.035
6 h after surgery	2.21 ± 1.321	3.11 ± 1.571,2	3.24 ± 1.621,2	0.001
12 h after surgery	3.77 ± 1.661	6.74 ± 1.991,2	7.65 ± 2.151,2,3	0.000
24 h after surgery	3.95 ± 1.141	4.85 ± 1.391,2	5.18 ± 1.531,2	0.000
Time of first flatus (h)	24.00 ± 11.03	19.70 ± 10.212	17.40 ± 5.312	0.003
Time of first defecation (h)	55.75 ± 26.95	36.91 ± 15.202	34.42 ± 12.92	0.000

¹P < 0.05 vs the same group 2 h before surgery.

²P < 0.05 vs the control group.

³P < 0.05 vs Xiao-Cheng-Qi decoction.

XD: Xiao-Cheng-Qi decoction; MXD: Modified Xiao-Cheng-Qi decoction.

Table 4 Diet after biliary surgery

Parameters	Control (n = 53)	XD (n = 54)	MXD (n = 55)	P value
Postoperative drinking time (h)	11.11 ± 7.26	8.88 ± 3.931	7.21 ± 3.201	0.076
Postoperative liquid diet time (h)	15.72 ± 8.98	12.74 ± 5.471	10.35 ± 4.241	0.049
Postoperative semi-liquid diet time (h)	27.92 ± 15.16	22.53 ± 9.331	17.98 ± 6.831,2	0.028
Postoperative normal diet time (h)	100.94 ± 39.04	94.80 ± 35.86	81.69 ± 29.07	0.333

¹P < 0.05 vs the control group.

²P < 0.05 vs Xiao-Cheng-Qi decoction.

XD: Xiao-Cheng-Qi decoction; MXD: Modified Xiao-Cheng-Qi decoction.

Table 5 Physical activity after biliary surgery

Activity indicators	Control (n = 53)	XD (n = 54)	MXD (n = 55)	P value
Activity time (min)
1 d after surgery	27.06 ± 8.29	28.50 ± 8.95	33.76 ± 12.411,2	0.107
2 d after surgery	41.73 ± 11.59	48.07 ± 14.571	57.02 ± 19.911,2	0.157
3 d after surgery	50.94 ± 12.00	61.91 ± 21.731	63.64 ± 19.631	0.201
4 d after surgery	59.24 ± 12.81	68.75 ± 19.54	78.08 ± 35.141	0.130
5 d after surgery	77.40 ± 21.77	85.17 ± 27.81	88.80 ± 22.32	0.481
Activity distance (m)
1 d after surgery	256.70 ± 94.97	284.57 ± 80.77	344.35 ± 134.011,2	0.127
2 d after surgery	397.19 ± 123.24	480.70 ± 163.851	630.60 ± 177.831,2	0.050
3 d after surgery	505.19 ± 151.09	571.75 ± 177.87	730.21 ± 200.951,2	0.013
4 d after surgery	651.82 ± 181.59	742.75 ± 195.40	782.69 ± 159.86	0.219
5 d after surgery	788.27 ± 236.58	792.50 ± 195.48	937.10 ± 145.73	0.162

¹P < 0.05 vs the control group.

²P < 0.05 vs Xiao-Cheng-Qi decoction.

XD: Xiao-Cheng-Qi decoction; MXD: Modified Xiao-Cheng-Qi decoction.

Table 6 Incidence of complications after biliary surgery

Parameters	Control (n = 53)	XD (n = 54)	MXD (n = 55)	P value
Incision complications	2 (3.77%)	1 (1.85%)	1 (1.82%)	0.761
Intra-abdominal infection	1 (1.89%)	0 (0%)	0 (0%)	0.761
Deep-vein thrombosis	0 (0%)	0 (0%)	0 (0%)	1.000
Bile leakage	1 (1.89%)	1 (1.85%)	0 (0%)	0.599
Nausea and vomiting	12 (22.64%)	3 (5.56%)1	2 (3.64%)1	0.001
Bloating	11 (20.75%)	4 (7.41%)1	3 (5.45%)1	0.009

¹P < 0.05 vs the control group.

XD: Xiao-Cheng-Qi decoction; MXD: Modified Xiao-Cheng-Qi decoction.

Table 7 Incidence of functional diarrhea in perioperative period

Parameters	Control (n = 53)	XD (n = 54)	MXD (n = 55)	P value
1d before surgery	2 (3.77%)	14 (25.93%)1	6 (10.91%)1,2	0.003
1d after surgery	1 (1.89%)	9 (16.67%)1	6 (10.91%)1	0.035
2 d after surgery	0 (0%)	8 (14.81%)1	5 (9.09%)1	0.017
3 d after surgery	2 (3.77%)	4 (7.41%)	2 (3.64%)	0.595
4 d after surgery	1 (1.89%)	2 (3.70%)	1 (1.82%)	0.777
5 d after surgery	2 (3.77%)	1 (1.85%)	2 (3.64%)	0.816

¹P < 0.05 vs the control group.

²P < 0.05 vs Xiao-Cheng-Qi decoction.

XD: Xiao-Cheng-Qi decoction; MXD: Modified Xiao-Cheng-Qi decoction.

Table 8 Levels of the indicators for acute inflammatory stress response and substance P in the perioperative period of biliary tract surgery

Indicators	Control (n = 53)	XD (n = 54)	MXD (n = 55)	P value
IL-6 (pg/mL)
1 d before surgery	4.89 ± 1.24	4.43 ± 1.46	4.26 ± 2.62	0.203
1 d after surgery	17.42 ± 6.671	10.63 ± 9.991,2	9.08 ± 8.631,2	0.000
2 d after surgery	11.09 ± 3.571	9.80 ± 6.511	6.13 ± 3.601,2,3	0.000
5 d after surgery	8.49 ± 2.311	7.22 ± 2.171	7.22 ± 3.391	0.487
IL-10 (pg/mL)
1 d before surgery	1.29 ± 0.50	1.25 ± 0.46	1.24 ± 0.23	0.798
1 d after surgery	1.27 ± 0.49	1.20 ± 0.61	1.21 ± 0.50	0.761
2 d after surgery	1.21 ± 0.51	1.23 ± 0.50	1.19 ± 0.37	0.942
5 d after surgery	1.33 ± 0.55	1.45 ± 0.53	1.39 ± 0.42	0.865
CRP (ng/mL)
1 d before surgery	6.19 ± 1.77	5.69 ± 2.40	5.59 ± 1.87	0.273
1 d after surgery	16.85 ± 7.731	10.84 ± 8.381,2	8.02 ± 3.441,2,3	0.000
2 d after surgery	17.90 ± 17.361	14.41 ± 11.361	8.83 ± 2.841,2,3	0.001
5 d after surgery	10.33 ± 3.111	10.49 ± 1.45	8.52 ± 2.68	0.170
SAA (ng/mL)
1 d before surgery	426.21 ± 48.96	415.64 ± 40.60	411.00 ± 47.39	0.214
1 d after surgery	9492.64 ± 1738.161	7807.52 ± 936.931,2	6953.98 ± 1228.381,2,3	0.000
2 d after surgery	14792.13 ± 6501.471	10573.74 ± 4074.711,2	9341.03 ± 1888.411,2	0.000
5 d after surgery	7817.09 ± 550.521	7396.66 ± 611.021	6911.41 ± 1464.141	0.132
Substance P (pg/mL)
1 d before surgery	40.73 ± 21.53	35.61 ± 19.79	36.14 ± 31.12	0.501
1 d after surgery	33.60 ± 16.051	37.30 ± 16.07	49.25 ± 41.491,2,3	0.009
2 d after surgery	28.23 ± 11.121	45.58 ± 24.071,2	51.73 ± 26.871,2	0.000
5 d after surgery	28.29 ± 11.90	27.55 ± 23.99	35.48 ± 23.70	0.653

¹P < 0.05 vs the same group before surgery.

²P < 0.05 vs the control group.

³P < 0.05 vs Xiao-Cheng-Qi decoction.

XD: Xiao-Cheng-Qi decoction; MXD: Modified Xiao-Cheng-Qi decoction; IL: Interleukin; CRP: C-reactive protein; SAA: Serum amyloid A.

Table 9 Spearman correlation between indicators of gastrointestinal function and inflammation on the second day after surgery (r, p)

Parameters	IL-6	IL-10	CRP	SAA	Substance P
Bowel sounds at 12 h after surgery	(0.25, ≤ 0.001)	(-0.03, 0.74)	(-0.22, ≤ 0.001)	(-0.33, ≤ 0.001)	(0.31, ≤ 0.001)
Time of first flatus	(0.20, 0.01)	(0.05, 0.55)	(0.35, ≤ 0.001)	(0.16, 0.04)	(-0.23, ≤ 0.001)
Time of first defecation	(0.14, 0.07)	(0.04, 0.59)	(0.30, ≤ 0.001)	(0.24, ≤ 0.001)	(-0.25, ≤ 0.001)
Postoperative liquid diet time	(0.19, 0.01)	(-0.02, 0.81)	(0.27, ≤ 0.001)	(0.08, 0.33)	(-0.10, 0.23)
Postoperative semi-liquid diet time	(0.09, 0.25)	(-0.00, 0.98)	(0.29, ≤ 0.001)	(0.11, 0.15)	(-0.15, 0.06)
Substance P	(-0.20, 0.01)	(-0.15, 0.06)	(-0.15, 0.05)	(-0.24, ≤ 0.001)	(1.00, ≤ 0.001)

XD: Xiao-Cheng-Qi decoction; MXD: Modified Xiao-Cheng-Qi decoction; IL: Interleukin; CRP: C-reactive protein; SAA: Serum amyloid A.