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[盆腔器官脱垂传统肠道准备与计划外术前准备的随机单盲比较]

[A randomized single blind comparison of conventional bowel preparation and unplanned preoperative preparation for pelvic organ prolapse].

作者信息

Deng H, Liu Y Y, Tan C, Zhao Y, Li X D, Yang X, Wang J L

机构信息

Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China.

出版信息

Zhonghua Fu Chan Ke Za Zhi. 2019 Feb 25;54(2):97-102. doi: 10.3760/cma.j.issn.0529-567x.2019.02.005.

Abstract

To investigate the influence of conventional preoperative intestinal preparation and unplanned preparation on the visual field of pelvic organ prolapse repair surgery. The patients who underwent transvaginal pelvic organ prolapse repair surgery in Peking University Peoples Hospital from September 2017 to July 2018 were selected as the research objects except those who had undergone colorectal surgery and chronic constipation. The surgery doctor was blinded by intestinal preparation. There was no intestinal preparation in non intestinal preparation group and polyethylene glycol was taken orally in intestinal preparation group. The main outcome measures were the effect of intestinal contents on the surgical field, the presence of fecal leakage, and the nature and volume of fecal leakage. The standard of fecal contamination was: mild, less than 15 ml, moderate, 15-30 ml, and severe, >30 ml. Secondary indicators were patient satisfaction and symptoms of routine bowel preparation. A total of 120 patients (60 cases of non intestinal preparation group, 60 cases of intestinal preparation group) were selected, including transvaginal hysterectomy, vaginal anterior or posterior colporrhaphy (some patients with anterior prolapse repair with mesh), sacrospinal ligament suspension, total colpectomy and colpocleisis, laparoscopic sacral colpopexy, anti-incontinence surgery. The median age of the patients in non intestinal preparation group was 62 years, and the median age of intestinal preparation group was 60 years. There were no significant differences in median age, anesthesia, operation method, blood loss, operation time and perioperative infection between the two groups (all 0.05). Fecal contamination occurred in 10% (6/60) of the patients without intestinal preparation and 32% (19/60) of the patients with intestinal preparation (0.042). Comparing the two groups, 10% (6/60) of the patients with intestinal preparation had moderate and severe contamination, and the patients without intestinal preparation was only 2% (1/60), there was significant difference (0.017). In intestinal preparation group, nausea (8%, 5/60), vomiting (5%, 3/60), abdominal distension (22%, 13/60), fatigue (5%, 3/60) and palpitation (2%, 1/60) were higher than those in non intestinal preparation group. Intestinal preparation with oral laxatives before pelvic organ prolapse repair surgery is not beneficial to the cleaning of the surgical field and increases the discomfort of intestinal preparation. It is safe and feasible for most patients with pelvic organ prolapse to perform pelvic organ prolapse repair surgery without intestinal preparation.

摘要

探讨传统术前肠道准备与非计划性准备对盆腔器官脱垂修复手术视野的影响。选取2017年9月至2018年7月在北京大学人民医院接受经阴道盆腔器官脱垂修复手术的患者作为研究对象,排除曾接受结直肠手术及慢性便秘患者。手术医生对肠道准备情况不知情。非肠道准备组不进行肠道准备,肠道准备组口服聚乙二醇。主要观察指标为肠道内容物对手术视野的影响、粪便渗漏情况及粪便渗漏的性质和量。粪便污染标准为:轻度,少于15毫升;中度,15至30毫升;重度,>30毫升。次要指标为患者满意度及常规肠道准备的症状。共选取120例患者(非肠道准备组60例,肠道准备组60例),包括经阴道子宫切除术、阴道前后壁修补术(部分前壁脱垂修补使用网片)、骶棘韧带悬吊术、全阴道切除术及阴道封闭术、腹腔镜骶骨阴道固定术、抗尿失禁手术。非肠道准备组患者中位年龄为62岁,肠道准备组中位年龄为60岁。两组患者在中位年龄、麻醉方式、手术方式、失血量、手术时间及围手术期感染方面均无显著差异(均P>0.05)。非肠道准备组患者粪便污染发生率为10%(6/60),肠道准备组为32%(19/60)(P=0.042)。两组比较,肠道准备组10%(6/60)患者出现中度及重度污染,非肠道准备组仅2%(1/60),差异有统计学意义(P=0.

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