使用不透射线标记物对择期结肠切除术后胃肠动力进行客观评估，为放弃术前机械性肠道准备提供了依据。
Objective assessment of postoperative gastrointestinal motility in elective colonic resection using a radiopaque marker provides an evidence for the abandonment of preoperative mechanical bowel preparation.
作者信息
Sasaki Junpei, Matsumoto Satoshi, Kan Hayato, Yamada Takeshi, Koizumi Michihiro, Mizuguchi Yoshiaki, Uchida Eiji
机构信息
Surgery for Organ Function and Biological Regulation, Graduated Medicine, Nippon Medical School, Tokyo, Japan.
出版信息
J Nippon Med Sch. 2012;79(4):259-66. doi: 10.1272/jnms.79.259.
BACKGROUND
It has been suggested that mechanical bowel preparation (MBP) has no benefit in terms of anastomotic healing, infection rate, or improvement in the postoperative course in patients undergoing elective colorectal surgery, and that it should be abandoned. However, the effect of MBP on postoperative gastrointestinal motility has been assessed subjectively. In this randomized trial, we objectively assessed the effect of MBP on postoperative gastrointestinal motility and mobility in elective colonic resection.
METHOD
In total, 79 patients scheduled to undergo elective colonic resection for cancer were randomized to MBP or no-MBP groups prior to surgery. All patients ingested radiopaque markers before surgery to evaluate postoperative gastrointestinal motility, objectively evaluated by the transition of the markers at postoperative days (PODs) 1, 3, 5 and 7. The groups were then further subdivided into open and laparoscopic-assisted colectomy (LAC) groups and evaluated in terms of gastrointestinal motility and postoperative mobility.
RESULTS
There was no significant difference between the no-MBP and MBP groups in terms of perioperative and postoperative course. In the LAC subgroup, there was no significant difference between the no-MBP and MBP groups in terms of marker transition. However, in the open subgroup, there was a significant difference between the groups in terms of the residual ratio of markers in the small intestine at POD 3 (no-MBP 35.3% vs. MBP 69.2%; p=0.041), excretion rate of markers at POD 5 (no-MBP 49.7% vs. MBP 8.8%; p=0.005), and residual ratio in the small intestine at POD 7 (no-MBP 3.1% vs. MBP 28.8%; p=0.028). Additionally, the excretion rate in the no-MBP group was significantly higher than in the MBP group at POD 7 (74.1% vs. 33.8%; p=0.007).
CONCLUSIONS
Our data provide additional evidence to support the abandonment of MBP in elective open colonic surgery.
背景
有人认为，机械性肠道准备（MBP）在择期结直肠手术患者的吻合口愈合、感染率或术后病程改善方面并无益处，应予以摒弃。然而，MBP对术后胃肠动力的影响一直是主观评估。在这项随机试验中，我们客观评估了MBP对择期结肠切除术后胃肠动力和活动能力的影响。
方法
总共79例计划接受择期结肠癌切除术的患者在手术前被随机分为MBP组或非MBP组。所有患者在手术前摄入不透X线的标志物，以评估术后胃肠动力，通过术后第1、3、5和7天（POD）标志物的转移情况进行客观评估。然后将这些组进一步细分为开放手术组和腹腔镜辅助结肠切除术（LAC）组，并对胃肠动力和术后活动能力进行评估。
结果
非MBP组和MBP组在围手术期和术后病程方面无显著差异。在LAC亚组中，非MBP组和MBP组在标志物转移方面无显著差异。然而，在开放手术亚组中，两组在术后第3天小肠中标志物的残留率（非MBP组35.3% vs. MBP组69.2%；p = 0.041）、术后第5天标志物的排泄率（非MBP组49.7% vs. MBP组8.8%；p = 0.005）以及术后第7天小肠中的残留率（非MBP组3.1% vs. MBP组28.8%；p = 0.028）方面存在显著差异。此外，术后第7天非MBP组的排泄率显著高于MBP组（74.1% vs. 33.8%；p = 0.007）。
结论
我们的数据提供了额外的证据，支持在择期开放性结肠手术中摒弃MBP。
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