Ji Woong Bae, Hahn Koo Yong, Kwak Jung Myun, Kang Dong Woo, Baek Se Jin, Kim Jin, Kim Seon Hahn
Division of Colorectal Surgery, Department of Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan-si, Republic of Korea.
Division of Colorectal Surgery, Department of Surgery, Chungju Hospital, Konkuk University, Chungju-si, Republic of Korea.
World J Surg. 2017 May;41(5):1366-1374. doi: 10.1007/s00268-016-3839-9.
Previous multicenter randomized trials demonstrated that omitting mechanical bowel preparation (MBP) did not increase anastomotic leakage rates or other infectious complications. However, the most serious concern regarding the omission of MBP is ongoing fecal peritonitis after anastomotic leakage occurs. The aim of this study was to compare the clinical manifestations and severity of anastomotic leakage between patients who underwent MBP and those who did not.
This study was a single-center retrospective review of a prospectively maintained database. From January 2006 to September 2013, 1369 patients who underwent elective rectal cancer resection with primary anastomosis were identified and analyzed.
Anastomotic leakage rates were not significantly different between patients who did not undergo MBP (77/831, 9.27%) and those who did (42/538, 7.81%). However, a significantly lower rate of clinical leakage requiring surgical exploration was observed in the leakage without MBP group (30/77, 39.0%) compared with the leakage with MBP group (30/42, 71.4%) (P = 0.001). There were no significant differences in the clinical severity of anastomotic leakage as assessed by the length of hospital stay, time to resuming a normal diet, length of antibiotic use, ileus rate, transfusion rate, ICU admission rate, and mortality rate between the leakage without MBP and leakage with MBP groups.
MBP was not found to affect the clinical severity of anastomotic leakage in elective rectal cancer surgery.
既往多中心随机试验表明，省略机械性肠道准备（MBP）并不会增加吻合口漏率或其他感染性并发症。然而，关于省略MBP最严重的担忧是吻合口漏发生后持续存在的粪性腹膜炎。本研究的目的是比较接受MBP和未接受MBP的患者吻合口漏的临床表现和严重程度。
本研究是对一个前瞻性维护数据库的单中心回顾性分析。2006年1月至2013年9月，确定并分析了1369例行择期直肠癌切除并一期吻合的患者。
未接受MBP的患者（77/831，9.27%）与接受MBP的患者（42/538，7.81%）之间的吻合口漏率无显著差异。然而，与接受MBP的吻合口漏组（30/42，71.4%）相比，未接受MBP的吻合口漏组中需要手术探查的临床漏率显著更低（30/77，39.0%）（P = 0.001）。未接受MBP的吻合口漏组与接受MBP的吻合口漏组之间，在住院时间、恢复正常饮食时间、抗生素使用时间、肠梗阻发生率、输血率、重症监护病房（ICU）入住率和死亡率等方面评估的吻合口漏临床严重程度无显著差异。
在择期直肠癌手术中，未发现MBP会影响吻合口漏的临床严重程度。
