Division of General and Laparoscopic Surgery, European Institute of Oncology, Milan, Italy.
Colorectal Dis. 2011 Oct;13(10):e327-34. doi: 10.1111/j.1463-1318.2011.02689.x.
Recent meta-analyses and randomized clinical trials have concluded that mechanical bowel preparation (MBP) before elective colorectal surgery is not associated with a reduction of surgical site infection (SSI). The aim of this randomized clinical trial was to evaluate the impact of preoperative MBP for colon and rectal cancer surgery in comparison with a single glycerine enema.
Patients scheduled for radical colorectal resection for malignancy with primary anastomosis were randomized to preoperative MBP (4 l of polyethylene glycol) (group 1, 114 patients) plus a glycerine 5% enema (2 l) or a single glycerine 5% enema (2 l) (group 2, 115 patients). The postoperative incidence of SSI was recorded prospectively. Patients undergoing minimally invasive surgery (laparoscopy or robotic) accounted for 55 and 51 in groups 1 and 2 respectively.
In all, 229 patients were included in the study, 114 in group 1 and 115 in group 2. At least one SSI was reported in 16 (14.0%) group 1 and in 20 (17.8%) group 2 patients (P=0.475). Perioperative mortality was nil. The incidence of SSI was comparable also in the 73 patients who had a low anterior resection (seven of 33 vs eight of 40, P=1.000), and for the 106 patients who underwent a minimally invasive procedure (nine of 55 vs four of 51, P=0.241).
A single large-volume glycerine enema is effective bowel preparation before colorectal resection whether performed by an open or minimally invasive technique.
最近的荟萃分析和随机临床试验得出结论，择期结直肠手术前进行机械肠道准备（MBP）与减少手术部位感染（SSI）无关。本随机临床试验的目的是评估与单次甘油灌肠相比，在结肠癌和直肠癌手术前进行MBP 的影响。
将计划行根治性结直肠切除术治疗恶性肿瘤并进行一期吻合的患者随机分为术前 MBP（4 升聚乙二醇）组（114 例患者）和 MBP 组（114 例患者）加甘油 5%灌肠（2 升）或单次甘油 5%灌肠（2 升）组（115 例患者）。前瞻性记录术后 SSI 的发生率。接受微创手术（腹腔镜或机器人）的患者分别占组 1 和组 2 的 55%和 51%。
共有 229 例患者纳入研究，组 1 114 例，组 2 115 例。组 1 中有 16 例（14.0%）至少报告了 1 例 SSI，组 2 中有 20 例（17.8%）（P=0.475）。围手术期无死亡病例。行低位前切除术的 73 例患者（33 例中有 7 例，40 例中有 8 例，P=1.000）和 106 例行微创手术的患者（55 例中有 9 例，51 例中有 4 例，P=0.241）之间的 SSI 发生率也相似。
无论采用开放还是微创技术，单次大剂量甘油灌肠是一种有效的结直肠切除术前肠道准备方法。
