择期结肠手术中机械性肠道准备是必需的吗？一项前瞻性随机研究。

Is mechanical bowel preparation mandatory for elective colon surgery? A prospective randomized study.

作者信息

Ram Edward, Sherman Yevgeni, Weil Ruben, Vishne Tali, Kravarusic Dragan, Dreznik Zeev

机构信息

Division of General Surgery, Rabin Medical Center, Campus Golda, Petach Tikva Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.

出版信息

Arch Surg. 2005 Mar;140(3):285-8. doi: 10.1001/archsurg.140.3.285.

DOI:10.1001/archsurg.140.3.285

PMID:15781794

Abstract

BACKGROUND

Bowel preparation prior to colonic surgery usually includes antibiotic therapy together with mechanical bowel preparation (MBP). Mechanical bowel preparation may cause discomfort to the patient, prolonged hospitalization, and water and electrolyte imbalance. It was assumed that with the improvement in surgical technique together with the use of more effective prophylactic antibiotics, it was possible that MBP would no longer be necessary.

HYPOTHESIS

There is no statistical difference in the postoperative results of patients who undergo elective colon resection with MBP as compared with those who have no MBP.

DESIGN AND PATIENTS

The study includes all patients who had elective large bowel resection at Campus Golda between April 1, 1999, and March 31, 2002. Emergency operations were not included. The patients were randomly assigned to the 2 study groups (with or without MBP) according to identification numbers. All patients were treated with intravenous and oral antibiotics prior to surgery. The patients in the MBP group received Soffodex for bowel preparation.

RESULTS

A total of 329 patients participated in the study, 165 without MBP and 164 with MBP. The 2 groups were similar in age, sex, and type of surgical procedure. Two hundred sixty-eight patients (81.5%) underwent surgery owing to colorectal cancer and 61 patients (18.5%) owing to benign disease. The hospitalization period was longer in the bowel-prepared group (mean +/- SD, 8.2 +/- 5.1 days) as compared with the nonprepared group (mean +/- SD, 8.0 +/- 2.7 days). However, this difference was not statistically significant. The time until the first bowel movement was similar between the 2 groups: a mean +/- SD of 4.2 +/- 1.3 days in the nonprepared group as compared with a mean +/- SD of 4.3 +/- 1.1 days in the prepared group (P = NS). Four patients (1.2%) died in the postoperative course owing to acute myocardial infarction and pulmonary embolism. Sixty-two patients (37.6%) of the non-MBP group suffered from postoperative complications as compared with 77 patients (46.9%) of the MBP group.

CONCLUSION

Our results suggest that no advantage is gained by preoperative MBP in elective colorectal surgery.

摘要

背景

结肠手术前的肠道准备通常包括抗生素治疗以及机械性肠道准备（MBP）。机械性肠道准备可能会给患者带来不适、延长住院时间并导致水和电解质失衡。人们认为，随着手术技术的改进以及使用更有效的预防性抗生素，机械性肠道准备可能不再必要。

假设

接受择期结肠切除术并进行机械性肠道准备的患者与未进行机械性肠道准备的患者相比，术后结果无统计学差异。

设计与患者

该研究纳入了1999年4月1日至2002年3月31日期间在戈尔达校区接受择期大肠切除术的所有患者。不包括急诊手术。根据识别号将患者随机分配到两个研究组（进行或不进行机械性肠道准备）。所有患者在手术前均接受静脉和口服抗生素治疗。机械性肠道准备组的患者接受Soffodex进行肠道准备。

结果

共有329名患者参与了该研究，165名未进行机械性肠道准备，164名进行了机械性肠道准备。两组在年龄、性别和手术方式方面相似。268名患者（81.5%）因结直肠癌接受手术，61名患者（18.5%）因良性疾病接受手术。肠道准备组的住院时间（平均±标准差，8.2±5.1天）比未进行肠道准备组（平均±标准差，8.0±2.7天）长。然而，这种差异无统计学意义。两组首次排便时间相似：未进行肠道准备组平均±标准差为4.2±1.3天，进行肠道准备组平均±标准差为4.3±1.1天（P=无显著性差异）。4名患者（1.2%）在术后因急性心肌梗死和肺栓塞死亡。未进行机械性肠道准备组的62名患者（37.6%）出现术后并发症，而机械性肠道准备组为77名患者（46.9%）。