Alcantara Moral Manuel, Serra Aracil Xavier, Bombardó Juncá Jordi, Mora López Laura, Hernando Tavira Ruben, Ayguavives Garnica Isidro, Aparicio Rodriguez Oscar, Navarro Soto Salvador
Servicio de Cirugía General y Aparato Digestivo, Corporación Sanitaria Parc Taulí, Sabadell, Barcelona, España.
Cir Esp. 2009 Jan;85(1):20-5. doi: 10.1016/S0009-739X(09)70082-X.
Mechanical preparation of the colon (MPC) in colorectal surgery has been a dogma that has been questioned over the last few years. The objective of this study is to demonstrate that morbidity in scheduled colorectal surgery is the same or lower without MPC.
Patients subjected to scheduled left colon and rectal surgery with primary anastomosis randomised into two groups. The "Preparation" group (MPC) received MPC and the "non-preparation" group (No-MPC) had only cleaning enemas. The variables collected were: demographic, oncological, nutritional, risk prediction models and morbidity-mortality.
Of the 193 patients included: 69 received MPC and 71 did not; 89 patients with colocolic anastomosis (MPC, 38; no MPC, 51) and 50 colorectal (MPC, 31; no MPC, 19). Statistically significant differences were seen in the overall analysis in favour of "no preparation" as regards morbidity (43.55 % with MPC and 27% with No MPC) and nosocomial infection (27.5% and 11.4%). There was 11.6% wound infections in the MPC compared to 5.7% in the no MPC, which was not statistically significant. The only mortalities were in the MPC group 2/69 (2.9% of patients). As regards the location of the anastomosis, in the colocolics the differences were more pronounced, with statistically significant differences in the morbidity, anastomosis dehiscence, and nosocomial infection variables. The effect of no MPC was not so evident in colorectal anastomosis.
Our results suggest that there is no benefit in MPC before surgery in colocolic anastomosis. No-MPC is not associated with a higher morbidity in wound infection or anastomotic dehiscence. In colorectal anastomosis the differences are not so evident, therefore a much bigger series needs to be studied.
在结直肠手术中，结肠机械性准备（MPC）一直是一个在过去几年中受到质疑的教条。本研究的目的是证明在计划性结直肠手术中，不进行MPC时的发病率相同或更低。
接受计划性左半结肠和直肠手术并进行一期吻合的患者被随机分为两组。“准备”组（MPC）接受MPC，“非准备”组（No-MPC）仅接受清洁灌肠。收集的变量包括：人口统计学、肿瘤学、营养状况、风险预测模型以及发病率和死亡率。
纳入的193例患者中：69例接受了MPC，71例未接受；89例进行结肠结肠吻合术（MPC组38例，No-MPC组51例），50例进行结直肠吻合术（MPC组31例，No-MPC组19例）。在总体分析中，在发病率（MPC组为43.55%，No-MPC组为27%）和医院感染方面（27.5%和11.4%），支持“不准备”的差异具有统计学意义。MPC组伤口感染率为11.6%，No-MPC组为5.7%，差异无统计学意义。仅在MPC组有2例死亡（占患者的2.9%）。关于吻合口的位置，在结肠结肠吻合术中差异更为明显，在发病率、吻合口裂开和医院感染变量方面存在统计学显著差异。在结直肠吻合术中，不进行MPC的效果不那么明显。
我们的结果表明，在结肠结肠吻合术前进行MPC没有益处。不进行MPC与伤口感染或吻合口裂开的较高发病率无关。在结直肠吻合术中差异不那么明显，因此需要研究更大规模的系列病例。
