Section of Urology, University of Chicago Medical Center, Chicago, Illinois, USA.
J Urol. 2012 Nov;188(5):1801-5. doi: 10.1016/j.juro.2012.07.039. Epub 2012 Sep 19.
The benefit of routine mechanical bowel preparation for patients undergoing radical cystectomy is not well established. We compared postoperative complications in patients who did or did not undergo mechanical bowel preparation before radical cystectomy.
In 2008 a single surgeon (GDS) performed open radical cystectomy with an ileal conduit or orthotopic neobladder in 105 consecutive patients with preoperative mechanical bowel preparation consisting of 4 l GoLYTELY®. In 2009 radical cystectomy with an ileal conduit or orthotopic neobladder was performed in 75 consecutive patients without mechanical bowel preparation. A comprehensive database provided clinical, pathological and outcome data.
All patients had complete perioperative data available. The 2 groups were similar in age, Charlson comorbidity score, diversion type, receipt of neoadjuvant radiation or chemotherapy, blood loss, hospital stay, time to diet and pathological stage. Postoperative urinary tract infection, wound dehiscence and perioperative death rates were similar in the 2 groups. Clostridium difficile infection developed within 30 days of surgery in 11 of 105 vs 2 of 75 patients with vs without mechanical bowel preparation (p = 0.08). When adjusted for the annual hospital-wide C. difficile rate, the difference remained insignificant (p = 0.21). Clavien grade 3 or greater abdominal and gastrointestinal complications, including fascial dehiscence, abdominal abscess, small bowel obstruction, bowel leak and entero-diversion fistula, developed in 7 of 105 patients with (6.7%) vs 11 of 75 without (14.7%) mechanical bowel preparation (p = 0.08).
The use of mechanical bowel preparation for patients undergoing radical cystectomy with an ileal conduit or orthotopic neobladder does not seem to impact the rates of perioperative infectious, wound and bowel complications. Larger series with multiple surgeons are necessary to confirm these findings.
根治性膀胱切除术患者常规机械肠道准备的益处尚未得到充分证实。我们比较了接受和未接受机械肠道准备的根治性膀胱切除术患者的术后并发症。
2008 年，一位外科医生（GDS）为 105 例患者进行了开放式根治性膀胱切除术，其中包括术前机械肠道准备，即服用 4 升 GoLYTELY®。2009 年，75 例患者在没有机械肠道准备的情况下进行了根治性膀胱切除术，其中包括行回肠造口术或原位新膀胱术。一个全面的数据库提供了临床、病理和结果数据。
所有患者均有完整的围手术期数据。两组患者的年龄、Charlson 合并症评分、转流类型、接受新辅助放疗或化疗、出血量、住院时间、饮食时间和病理分期相似。两组患者的术后尿路感染、伤口裂开和围手术期死亡率相似。105 例患者中有 11 例（10.5%）与 75 例患者中有 2 例（2.7%）在手术后 30 天内发生艰难梭菌感染（p = 0.08）。当调整年度全院艰难梭菌感染率时，差异仍无统计学意义（p = 0.21）。7 例（6.7%）接受机械肠道准备的患者与 11 例（14.7%）未接受机械肠道准备的患者发生了 3 级或更高级别的腹部和胃肠道并发症，包括筋膜裂开、腹部脓肿、小肠梗阻、肠漏和肠转流瘘（p = 0.08）。
对于行回肠造口术或原位新膀胱术的根治性膀胱切除术患者，使用机械肠道准备似乎不会影响围手术期感染、伤口和肠道并发症的发生率。需要更多的多外科医生的大系列研究来证实这些发现。
