Barbieux J, Hamy A, Talbot M F, Casa C, Mucci S, Lermite E, Venara A
CHU d'Angers, service de chirurgie viscérale et endocrinienne, 4, rue Larrey, 49933 Angers cedex 9, France; L'UNAM, université d'Angers, 49000 Angers, France.
CHU d'Angers, département d'anesthésie-réanimation, 4, rue Larrey, 49933 Angers cedex 9, France.
J Visc Surg. 2017 Apr;154(2):79-85. doi: 10.1016/j.jviscsurg.2016.08.003. Epub 2016 Sep 8.
While enhanced recovery after surgery (ERAS) has been proven to improve results in colorectal operations with regard to morbidity and duration of hospital stay, its impact on recovery of bowel motility is poorly documented. The aims of this study were to assess the impact of ERAS on bowel motility recovery, and to assess the consequences of the definition of postoperative ileus on its reported incidence in the literature.
This is a single-center prospective observational study of consecutive patients who underwent colorectal resection with anastomosis over a period of 17 months. Global resumption of intestinal transit (GROT) was defined as passage of stool combined with alimentary tolerance of solid food.
One hundred and thirty-one patients were included. A median of 14 items (range: 13-16) was complied out of 19 observable items in the protocol. Median time to passage of flatus (MTPF) was 2 days and the GROT was 3 days. The time interval to MTPF as well as to GROT decreased as adherence to the ERAS protocol increased (respectively P<0.001, r=0.11 and P=0.04, r=0.06). The incidence of postoperative "ileus" varied from 1.5% to 61.8% depending on the interval chosen to define ileus (cut-off from 1 to 7 days). Adherence to≥85% of the items in the ERAS protocol protected patients from "prolonged ileus", i.e., lasting≥4 days (OR=0.35; 95% CI=0.15 to 0.83).
The implementation of and compliance with an ERAS protocol allowed a reduction in the time to GROT. There is a need for a consensual definition of postoperative ileus.
虽然手术加速康复（ERAS）已被证明可改善结直肠手术的发病率和住院时间，但对其对肠道动力恢复的影响记录甚少。本研究的目的是评估ERAS对肠道动力恢复的影响，并评估术后肠梗阻定义对其在文献中报道的发病率的影响。
这是一项单中心前瞻性观察研究，对连续17个月接受结直肠切除吻合术的患者进行研究。肠道传输功能的全面恢复（GROT）定义为排便并伴有对固体食物的消化耐受性。
纳入131例患者。方案中19项可观察项目的中位数为14项（范围：13 - 16项）。排气中位时间（MTPF）为2天，GROT为3天。随着对ERAS方案依从性的增加，达到MTPF以及GROT的时间间隔缩短（分别为P<0.001，r = 0.11和P = 0.04，r = 0.06）。术后“肠梗阻”的发病率从1.5%到61.8%不等，取决于定义肠梗阻的时间间隔（截止时间为1至7天）。对ERAS方案中≥85%的项目的依从性可使患者免受“持续性肠梗阻”，即持续≥4天（OR = 0.35；95%CI = 0.15至0.83）。
实施并遵守ERAS方案可减少达到GROT的时间。需要对术后肠梗阻有一个共识性的定义。
