Pittet O, Nocito A, Balke H, Duvoisin C, Clavien P A, Demartines N, Hahnloser D
Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland.
Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.
Colorectal Dis. 2015 Nov;17(11):1007-10. doi: 10.1111/codi.12974.
According to the French GRECCAR III randomized trial, full mechanical bowel preparation (MBP) for rectal surgery decreases the rate of postoperative morbidity, in particular postoperative infectious complications, but MBP is not well tolerated by the patient. The aim of the present study was to determine whether a preoperative rectal enema (RE) might be an alternative to MBP.
An analysis was performed of 96 matched cohort patients undergoing rectal resection with primary anastomosis and protective ileostomy at two different university teaching hospitals, whose rectal cancer management was comparable except for the choice of preoperative bowel preparation (MBP or RE). Prospective databases were retrospectively analysed.
Patients were well matched for age, gender, body mass index and Charlson index. The surgical approach and cancer characteristics (level above anal verge, stage and use of neoadjuvant therapy) were comparable between the two groups. Anastomotic leakage occurred in 10% of patients having MBP and in 8% having RE (P = 1.00). Pelvic abscess formation (6% vs 2%, P = 0.63) and wound infection (8% vs 15%, P = 0.55) were also comparable. Extra-abdominal infection (13% vs 13%, P = 1.00) and non-infectious abdominal complications such as ileus and bleeding (27% and 31%, P = 0.83) were not significantly different. Overall morbidity was comparable in the two groups (50% vs 54%, P = 0.83).
A simple RE before rectal surgery seems not to be associated with more postoperative infectious complications nor a higher overall morbidity than MBP.
根据法国GRECCAR III随机试验，直肠手术的全机械肠道准备（MBP）可降低术后发病率，尤其是术后感染性并发症的发生率，但患者对MBP的耐受性不佳。本研究的目的是确定术前直肠灌肠（RE）是否可作为MBP的替代方法。
对在两家不同大学教学医院接受直肠切除并一期吻合及保护性回肠造口术的96例匹配队列患者进行分析，除术前肠道准备方式（MBP或RE）的选择外，两组患者的直肠癌治疗情况具有可比性。对前瞻性数据库进行回顾性分析。
患者在年龄、性别、体重指数和查尔森指数方面匹配良好。两组的手术方式和癌症特征（距肛缘高度、分期及新辅助治疗的使用情况）具有可比性。接受MBP的患者中10%发生吻合口漏，接受RE的患者中8%发生吻合口漏（P = 1.00）。盆腔脓肿形成（6%对2%，P = 0.63）和伤口感染（8%对15%，P = 0.55）也具有可比性。腹外感染（13%对13%，P = 1.00）以及肠梗阻和出血等非感染性腹部并发症（27%和31%，P = 0.83）无显著差异。两组的总体发病率具有可比性（50%对54%，P = 0.83）。
直肠手术前单纯的RE似乎与比MBP更多的术后感染性并发症或更高的总体发病率无关。
