肠道准备在结直肠手术中的作用：2012-2015 年 ACS-NSQIP 数据结果。

The Role of Bowel Preparation in Colorectal Surgery: Results of the 2012-2015 ACS-NSQIP Data.

机构信息

Department of Colon and Rectal Surgery, Ochsner Medical Center, New Orleans, LA and Ochsner Clinic School, University of Queensland School of Medicine, Brisbane, Queensland, Australia.

Department of Medicine, University of Texas Health Sciences Center, Houston, TX.

出版信息

Ann Surg. 2019 Apr;269(4):671-677. doi: 10.1097/SLA.0000000000002568.

DOI:10.1097/SLA.0000000000002568

PMID:29064902

Abstract

OBJECTIVE

To analyze potential benefits with regards to infectious complications with combined use of mechanical bowel preparation (MBP) and ABP in elective colorectal resections.

BACKGROUND

Despite recent literature suggesting that MBP does not reduce infection rate, it still is commonly used. The use of oral antibiotic bowel preparation (ABP) has been practiced for decades but its use is also controversial.

METHODS

Patients undergoing elective colorectal resection in the 2012 to 2015 American College of Surgeons National Surgical Quality Improvement Program cohorts were selected. Doubly robust propensity score-adjusted multivariable regression was conducted for infectious and other postoperative complications.

RESULTS

A total of 27,804 subjects were analyzed; 5471 (23.46%) received no preparation, 7617 (32.67%) received MBP only, 1374 (5.89%) received ABP only, and 8855 (37.98%) received both preparations. Compared to patients receiving no preparation, those receiving dual preparation had less surgical site infection (SSI) [odds ratio (OR) = 0.39, P < 0.001], organ space infection (OR = 0.56, P ≤ 0.001), wound dehiscence (OR = 0.43, P = 0.001), and anastomotic leak (OR = 0.53, P < 0.001). ABP alone compared to no prep resulted in significantly lower rates of surgical site infection (OR = 0.63, P = 0.001), organ space infection (OR = 0.59, P = 0.005), anastomotic leak (OR = 0.53, P = 0.002). MBP showed no significant benefit to infectious complications when used as monotherapy.

CONCLUSIONS

Combined MBP/ABP results in significantly lower rates of SSI, organ space infection, wound dehiscence, and anastomotic leak than no preparation and a lower rate of SSI than ABP alone. Combined bowel preparation significantly reduces the rates of infectious complications in colon and rectal procedures without increased risk of Clostridium difficile infection. For patients undergoing elective colon or rectal resection we recommend bowel preparation with both mechanical agents and oral antibiotics whenever feasible.

摘要

目的

分析在择期结直肠切除术中联合使用机械性肠道准备（MBP）和口服抗生素肠道准备（ABP）的潜在感染并发症获益。

背景

尽管最近的文献表明 MBP 并不能降低感染率，但它仍然被广泛应用。口服抗生素肠道准备（ABP）的应用已经有几十年的历史，但它的应用也存在争议。

方法

选取 2012 年至 2015 年美国外科医师学会国家手术质量改进计划队列中接受择期结直肠切除术的患者。采用双重稳健倾向评分调整的多变量回归分析感染和其他术后并发症。

结果

共分析了 27804 例患者；5471 例（23.46%）未接受准备，7617 例（32.67%）仅接受 MBP，1374 例（5.89%）仅接受 ABP，8855 例（37.98%）接受两种准备。与未接受准备的患者相比，接受双重准备的患者手术部位感染（SSI）发生率较低[比值比（OR）=0.39，P<0.001]、器官间隙感染（OR=0.56，P≤0.001）、伤口裂开（OR=0.43，P=0.001）和吻合口漏（OR=0.53，P<0.001）。ABP 单独应用与无准备相比，SSI 发生率显著降低（OR=0.63，P=0.001）、器官间隙感染（OR=0.59，P=0.005）、吻合口漏（OR=0.53，P=0.002）。MBP 单独应用对感染并发症没有显著获益。

结论

与无准备相比，MBP/ABP 联合应用可显著降低 SSI、器官间隙感染、伤口裂开和吻合口漏的发生率，且 SSI 发生率低于 ABP 单独应用。联合肠道准备可显著降低结直肠手术的感染并发症发生率，而不会增加艰难梭菌感染的风险。对于接受择期结肠或直肠切除术的患者，我们建议在可行的情况下使用机械和口服抗生素进行肠道准备。