Gravante Gianpiero, Caruso Riccardo, Andreani Stefano Michele, Giordano Pasquale
Department of Colorectal Surgery, Whipps Cross University Hospital, Leytonstone, London, E11 1NR, UK.
Int J Colorectal Dis. 2008 Dec;23(12):1145-50. doi: 10.1007/s00384-008-0592-z. Epub 2008 Oct 4.
Several studies concluded that mechanical bowel preparation (MBP) does not confer any advantage on reducing the anastomotic leak rate or wound infections. The aim of this meta-analysis was to review all prospective randomised controlled trials on the use of MBP before colorectal surgery in order to find differences in the rates of abdominal and systemic complications in view of recent published articles.
Review of all randomised prospective trials compare MBP vs. non-MBP. Primary outcome measures were anastomotic leakages, abdomino-pelvic abscesses and postoperative ileus. Secondary outcomes were wound infections, extra-abdominal complications (urinary infections, pulmonary infections, deep venous thrombosis or pulmonary embolism, cardiac events), sepsis and mortality.
Twelve articles met the inclusion criteria with 4,919 patients. The non-MBP group showed no significant increase of the anastomotic leakages (3.4% vs. 4.1%; p = NS) and wound infections (8.7% vs. 9.6%; p = NS) but had a lower rate of postoperative cardiac events (2.5% vs. 4.0%; p = 0.04).
The evidence from recent studies, combined with previous ones, further suggests that the dogma of the necessity of mechanical bowel preparation before elective colorectal surgery should be reconsidered.
多项研究得出结论，机械性肠道准备（MBP）在降低吻合口漏率或伤口感染方面并无任何优势。鉴于近期发表的文章，本荟萃分析的目的是回顾所有关于结直肠手术前使用MBP的前瞻性随机对照试验，以找出腹部和全身并发症发生率的差异。
回顾所有比较MBP与非MBP的随机前瞻性试验。主要结局指标为吻合口漏、腹盆腔脓肿和术后肠梗阻。次要结局为伤口感染、腹部外并发症（尿路感染、肺部感染、深静脉血栓形成或肺栓塞、心脏事件）、脓毒症和死亡率。
12篇文章符合纳入标准，涉及4919例患者。非MBP组的吻合口漏（3.4%对4.1%；p=无统计学意义）和伤口感染（8.7%对9.6%；p=无统计学意义）无显著增加，但术后心脏事件发生率较低（2.5%对4.0%；p=0.04）。
近期研究的证据与之前的研究相结合，进一步表明，择期结直肠手术前进行机械性肠道准备必要性的教条应重新审视。
