不进行机械肠道准备的结肠和直肠手术：一项随机前瞻性试验。
Colon and rectal surgery without mechanical bowel preparation: a randomized prospective trial.
作者信息
Zmora Oded, Mahajna Ahmad, Bar-Zakai Barak, Rosin Danny, Hershko Dan, Shabtai Moshe, Krausz Michael M, Ayalon Amram
机构信息
Department of Surgery, Sheba Medical Center and Sackler School of Medicine, Tel Aviv, Israel.
出版信息
Ann Surg. 2003 Mar;237(3):363-7. doi: 10.1097/01.SLA.0000055222.90581.59.
OBJECTIVE
To assess whether elective colon and rectal surgery can be safely performed without preoperative mechanical bowel preparation.
SUMMARY BACKGROUND DATA
Mechanical bowel preparation is routinely done before colon and rectal surgery, aimed at reducing the risk of postoperative infectious complications. However, in cases of penetrating colon trauma, primary colonic anastomosis has proven to be safe even though the bowel is not prepared.
METHODS
Patients undergoing elective colon and rectal resections with primary anastomosis were prospectively randomized into two groups. Group A had mechanical bowel preparation with polyethylene glycol before surgery, and group B had their surgery without preoperative mechanical bowel preparation. Patients were followed up for 30 days for wound, anastomotic, and intra-abdominal infectious complications.
RESULTS
Three hundred eighty patients were included in the study, 187 in group A and 193 in group B. Demographic characteristics, indications for surgery, and type of surgical procedure did not significantly differ between the two groups. Colo-colonic or colorectal anastomosis was performed in 63% of the patients in group A and 66% in group B. There was no difference in the rate of surgical infectious complications between the two groups. The overall infectious complications rate was 10.2% in group A and 8.8% in group B. Wound infection, anastomotic leak, and intra-abdominal abscess occurred in 6.4%, 3.7%, and 1.1% versus 5.7%, 2.1%, and 1%, respectively.
CONCLUSIONS
These results suggest that elective colon and rectal surgery may be safely performed without mechanical preparation.
目的
评估择期结肠和直肠手术在不进行术前机械性肠道准备的情况下是否能安全进行。
总结背景数据
结肠和直肠手术前常规进行机械性肠道准备，旨在降低术后感染并发症的风险。然而，在穿透性结肠创伤病例中，即使未进行肠道准备，一期结肠吻合术已被证明是安全的。
方法
将接受择期结肠和直肠切除并一期吻合术的患者前瞻性随机分为两组。A组在手术前用聚乙二醇进行机械性肠道准备，B组在没有术前机械性肠道准备的情况下进行手术。对患者进行30天的随访，观察伤口、吻合口和腹腔内感染并发症情况。
结果
380例患者纳入研究，A组187例，B组193例。两组患者的人口统计学特征、手术指征和手术方式类型无显著差异。A组63%的患者和B组66%的患者进行了结肠-结肠或结肠-直肠吻合术。两组手术感染并发症发生率无差异。A组总体感染并发症发生率为10.2%，B组为8.8%。伤口感染、吻合口漏和腹腔内脓肿的发生率分别为6.4%、3.7%和1.1%，而B组分别为5.7%、2.1%和1%。
结论
这些结果表明，择期结肠和直肠手术在不进行机械性准备的情况下可能安全进行。
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