Pirró N, Ouaissi M, Sielezneff I, Fakhro A, Pieyre A, Consentino B, Sastre B
Service de chirurgie digestive, hôpital Sainte-Marguerite, 270, boulevard de Sainte-Marguerite, 13274 Marseille cedex 09, France.
Ann Chir. 2006 Oct;131(8):442-6. doi: 10.1016/j.anchir.2006.03.016. Epub 2006 Apr 7.
Mechanical bowel preparation (MBP), aimed at reducing the infectious complications of colorectal surgery, was considered as indispensable. This benefit is actually disputed. The aim of this study was to report an experience of colorectal surgery without MBP.
Hundred ninety patients without MBP and without low residue diet, who underwent colorectal surgery with primary anastomosis not requiring a diverting stoma were included. The main outcome were the rate of mortality, anastomotic leak, wound infection and intra-abdominal abscess. Secondary outcomes were duration of intravenous perfusion, nasogastric aspiration, total hospitalisation stay and time to realimentation.
The procedure was performed by laparotomy (n=142) or laparoscopy (n=48). Forty-eight patients underwent emergency surgery. Ninety-two patients were operated for malignancy. The rate of mortality was 6.3% in correlation with the scale of AFC. The rate of anastomotic leak was 3.7%. The rate of specific morbidity was independent of scale of AFC on the contrary to the frequency of non-specific complications. The mean duration of intravenous perfusion and nasogastric suction were 6 days and 0.3 day. The patient had normal diet to the 4th day (4+/-3 days). The mean hospital stay was 13.4 days.
The colorectal surgery without MBP may be safely performed and could improve the quality of life of patients in the perioperatory period.
旨在降低结直肠手术感染并发症的机械性肠道准备（MBP）曾被认为是必不可少的。但这一益处实际上存在争议。本研究的目的是报告无MBP的结直肠手术经验。
纳入190例未进行MBP且未采用低渣饮食、接受结直肠手术且一期吻合无需造口分流的患者。主要结局指标为死亡率、吻合口漏、伤口感染和腹腔内脓肿发生率。次要结局指标为静脉输液时间、胃肠减压时间、总住院时间和恢复进食时间。
手术通过开腹（n = 142）或腹腔镜（n = 48）进行。48例患者接受急诊手术。92例患者因恶性肿瘤接受手术。死亡率为6.3%，与美国麻醉医师协会（AFC）分级相关。吻合口漏发生率为3.7%。特异性发病率与AFC分级无关，而非特异性并发症的发生频率则与之相关。静脉输液和胃肠减压的平均时间分别为6天和0.3天。患者在术后第4天（4±3天）恢复正常饮食。平均住院时间为13.4天。
无MBP的结直肠手术可以安全进行，并且可以改善患者围手术期的生活质量。
