择期左侧结直肠癌手术前机械性肠道准备与不准备的随机临床试验。

Randomized clinical trial of mechanical bowel preparation versus no preparation before elective left-sided colorectal surgery.

作者信息

Bucher P, Gervaz P, Soravia C, Mermillod B, Erne M, Morel P

机构信息

Clinic of Visceral and Transplantation Surgery, Department of Surgery, Geneva University Hospital, Geneva 14, Switzerland.

出版信息

Br J Surg. 2005 Apr;92(4):409-14. doi: 10.1002/bjs.4900.

DOI:10.1002/bjs.4900

PMID:15786427

Abstract

BACKGROUND

Mechanical bowel preparation (MBP) is performed routinely before colorectal surgery to reduce the risk of postoperative infectious complications. The aim of this randomized clinical trial was to compare the outcome of patients who underwent elective left-sided colorectal surgery with or without MBP.

METHODS

Patients scheduled for elective left-sided colorectal resection with primary anastomosis were randomized to preoperative MBP (3 litres of polyethylene glycol) (group 1) or surgery without MBP (group 2). Postoperative abdominal infectious complications and extra-abdominal morbidity were recorded prospectively.

RESULTS

One hundred and fifty-three patients were included in the study, 78 in group 1 and 75 in group 2. Demographic, clinical and treatment characteristics did not differ significantly between the two groups. The overall rate of abdominal infectious complications (anastomotic leak, intra-abdominal abscess, peritonitis and wound infection) was 22 per cent in group 1 and 8 per cent in group 2 (P = 0.028). Anastomotic leak occurred in five patients (6 per cent) in group 1 and one (1 per cent) in group 2 (P = 0.210) [corrected] Extra-abdominal morbidity rates were 24 and 11 per cent respectively (P = 0.034). Hospital stay was longer for patients who had MBP (mean(s.d.) 14.9(13.1) versus 9.9(3.8) days; P = 0.024).

CONCLUSION

Elective left-sided colorectal surgery without MBP is safe and is associated with reduced postoperative morbidity.

摘要

背景

结直肠手术前常规进行机械性肠道准备（MBP）以降低术后感染并发症的风险。这项随机临床试验的目的是比较接受择期左侧结直肠手术的患者在进行或不进行MBP情况下的结局。

方法

计划进行择期左侧结直肠切除并一期吻合的患者被随机分为术前MBP组（3升聚乙二醇）（第1组）或不进行MBP的手术组（第2组）。前瞻性记录术后腹部感染并发症和腹部外发病率。

结果

153例患者纳入研究，第1组78例，第2组75例。两组的人口统计学、临床和治疗特征无显著差异。腹部感染并发症的总发生率（吻合口漏、腹腔内脓肿、腹膜炎和伤口感染）在第1组为22%，在第2组为8%（P = 0.028）。吻合口漏在第1组5例患者（6%）中发生，在第2组1例（1%）中发生（P = 0.210）[校正后]。腹部外发病率分别为24%和11%（P = 0.034）。接受MBP的患者住院时间更长（均值（标准差）14.9（13.1）天对9.9（3.8）天；P = 0.024）。