Yamada Takeshi, Kan Hayato, Matsumoto Satoshi, Koizumi Michihiro, Matsuda Akihisa, Shinji Seiichi, Sasaki Junpei, Uchida Eiji
Department of Gastrointestinal and Hepato-Billiary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan.
Department of Gastrointestinal and Hepato-Billiary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan.
J Surg Res. 2014 Sep;191(1):84-90. doi: 10.1016/j.jss.2014.03.001. Epub 2014 Mar 11.
The effects of mechanical bowel preparation (MBP) on morbidity (e.g., anastomotic leakage and surgical site infection) have been evaluated. Its effect on early recovery after surgery has drawn renewed attention, and its use is discouraged in the postsurgical management of enhanced recovery. However, most surgeons in Japan prefer polyethylene glycol (PEG) for MBP. We investigated the effect of MBP with PEG on postoperative intestinal motility.
We prospectively evaluated a consecutive series of 258 colon cancer patients who underwent colonic resection and primary anastomosis. We orally administered 2000 mL of PEG in the PEG group and did not administer PEG to patients in the no-PEG group. Postoperative gastrointestinal motility was assessed with radiopaque markers. All patients ingested radiopaque markers 2 h before surgery. Postoperative intestinal motility was radiologically assessed by counting the number of residual markers. Abdominal radiography was conducted on postoperative days 1, 3, and 5 to count residual markers in the large and small intestines.
The total number of residual markers in the no-PEG group was less than that in the PEG group on day 5 (P < 0.01) but not on days 1 and 3. On all 3 d, the numbers of residual markers in the small intestine were significantly less in the no-PEG group than in the PEG group (P < 0.001). There were no differences in postoperative complications between the no-PEG and PEG groups.
PEG can negatively affect postoperative intestinal motility, and MBP using PEG is unnecessary in elective colon cancer surgery.
机械性肠道准备（MBP）对发病率（如吻合口漏和手术部位感染）的影响已得到评估。其对术后早期恢复的影响再次受到关注，在促进恢复的术后管理中不鼓励使用。然而，日本的大多数外科医生在进行机械性肠道准备时更喜欢使用聚乙二醇（PEG）。我们研究了使用PEG进行机械性肠道准备对术后肠道蠕动的影响。
我们前瞻性地评估了连续258例行结肠切除术和一期吻合术的结肠癌患者。PEG组口服2000 mL PEG，非PEG组患者不使用PEG。用不透X线标志物评估术后胃肠蠕动。所有患者在手术前2小时摄入不透X线标志物。通过计算残留标志物的数量对术后肠道蠕动进行放射学评估。在术后第1、3和5天进行腹部X线检查，以计算大肠和小肠中的残留标志物数量。
在第5天，非PEG组的残留标志物总数少于PEG组（P < 0.01），但在第1天和第3天并非如此。在所有3天中，非PEG组小肠中的残留标志物数量均显著少于PEG组（P < 0.001）。非PEG组和PEG组术后并发症无差异。
PEG会对术后肠道蠕动产生负面影响，在择期结肠癌手术中使用PEG进行机械性肠道准备是不必要的。
