Murray A C A, Kiran R P
Division of Colorectal Surgery, New York Presbyterian Hospital, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, Floor 8, New York City, 10032, NY, USA.
Mailman School of Public Health, Columbia University, 722 W 168th St, New York City, 10032, NY, USA.
Langenbecks Arch Surg. 2016 Aug;401(5):573-80. doi: 10.1007/s00423-016-1461-9. Epub 2016 Jun 20.
Back in the 1970s, the administration of oral antibiotics combined with mechanical bowel preparation prior to colorectal surgery was considered standard procedure and adopted widely. Subsequent evidence suggested that bowel cleansing was unnecessary, even harmful, and hence was abandoned. Most recent evidence, however, suggests that full preparation significantly improves a spectrum of colectomy-specific postoperative outcomes.
The purpose of this review was to describe existing literature regarding the optimal bowel preparation regimen prior to elective colorectal resection. In addition, we evaluate the available evidence on each component-oral antibiotics, mechanical bowel preparation and intravenous antibiotics, with regard to short-term postoperative outcomes.
Current best evidence suggests that colorectal resection should be preceded by a combination of oral antibiotics, mechanical bowel preparation and intravenous antibiotics at induction. Further randomized controlled trials are required due to a paucity of level 1 evidence.
早在20世纪70年代，结直肠手术前口服抗生素联合机械性肠道准备被视为标准程序并广泛采用。随后的证据表明肠道清洁是不必要的，甚至是有害的，因此被摒弃。然而，最新证据表明充分准备能显著改善一系列结肠切除术特定的术后结局。
本综述的目的是描述关于择期结直肠切除术前最佳肠道准备方案的现有文献。此外，我们评估了关于口服抗生素、机械性肠道准备和静脉抗生素各组成部分对术后短期结局的现有证据。
目前的最佳证据表明，结直肠切除术前应在诱导时联合使用口服抗生素、机械性肠道准备和静脉抗生素。由于一级证据不足，需要进一步的随机对照试验。
