Moghadamyeghaneh Zhobin, Hanna Mark H, Carmichael Joseph C, Mills Steven D, Pigazzi Alessio, Nguyen Ninh T, Stamos Michael J
Department of Surgery, University of California, Irvine, School of Medicine, Irvine, CA.
Department of Surgery, University of California, Irvine, School of Medicine, Irvine, CA.
J Am Coll Surg. 2015 May;220(5):912-20. doi: 10.1016/j.jamcollsurg.2015.02.008. Epub 2015 Feb 14.
There are limited data comparing the outcomes of preoperative oral antibiotic bowel preparation (OBP) and mechanical bowel preparation (MBP) in colorectal surgery. We sought to identify the relationship between preoperative bowel preparations (BP) and postoperative complications in colon cancer surgery.
The NSQIP database was used to examine the clinical data of colon cancer patients undergoing scheduled colon resection during 2012 to 2013. Multivariate regression analysis was performed to identify correlations between BP and postoperative complications.
We evaluated a total of 5,021 patients who underwent elective colon resection. Of these, 44.8% had only MBP, 2.3% had only OBP, 27.6% had both MBP and OBP, and 25.3% of patients did not have any type of BP. In multivariate analysis of data, MBP and OBP were not associated with decreased risk of postoperative complications in right side (adjusted odds ratio [AOR] 0.80, 0.30, p = 0.08, 0.10, respectively) or left side colon resections (AOR 1.02, 0.68, p = 0.81, 0.24, respectively). However, the combination of MBP and OBP before left side colon resections resulted in a significantly decreased risk of overall morbidity (AOR 0.63, p < 0.01), superficial surgical site infection (AOR 0.31, p < 0.01), anastomosis leakage (AOR 0.44, p < 0.01), and intra-abdominal infections (AOR 0.44, p < 0.01).
Our analysis revealed that solitary mechanical bowel preparation and solitary oral bowel preparation had no significant effects on major postoperative complications after colon cancer resection. However, a combination of mechanical and oral antibiotic preparations showed a significant decrease in postoperative morbidity.
关于结直肠癌手术中术前口服抗生素肠道准备（OBP）和机械肠道准备（MBP）效果比较的数据有限。我们试图确定结肠癌手术中术前肠道准备（BP）与术后并发症之间的关系。
使用NSQIP数据库检查2012年至2013年期间接受计划性结肠切除术的结肠癌患者的临床数据。进行多变量回归分析以确定BP与术后并发症之间的相关性。
我们共评估了5021例行择期结肠切除术的患者。其中，44.8%仅接受MBP，2.3%仅接受OBP，27.6%同时接受MBP和OBP，25.3%的患者未进行任何类型的BP。在数据的多变量分析中，MBP和OBP与右侧（校正比值比[AOR]分别为0.80、0.30，p = 0.08、0.10）或左侧结肠切除术（AOR分别为1.02、0.68，p = 0.81、0.24）术后并发症风险降低无关。然而，左侧结肠切除术前MBP和OBP联合使用可显著降低总体发病率（AOR 0.63，p < 0.01）、浅表手术部位感染（AOR 0.31，p < 0.01）、吻合口漏（AOR 0.44，p < 0.01）和腹腔内感染（AOR 0.44，p < 0.01）的风险。
我们的分析表明，单独的机械肠道准备和单独的口服肠道准备对结肠癌切除术后的主要并发症没有显著影响。然而，机械和口服抗生素联合准备可显著降低术后发病率。
