肠道准备在开放、微创和转为开放结直肠切除术中的作用。

The Role of Bowel Preparation in Open, Minimally Invasive, and Converted-to-Open Colectomy.

机构信息

Department of Surgery, Yale School of Medicine, New Haven, Connecticut.

Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

出版信息

J Surg Res. 2019 Oct;242:183-192. doi: 10.1016/j.jss.2019.02.039. Epub 2019 May 11.

DOI:10.1016/j.jss.2019.02.039

PMID:31085366

Abstract

BACKGROUND

Bowel preparation before colectomy is considered an effective strategy to decrease postoperative complications. However, data regarding the effect of bowel preparation in patients undergoing minimally invasive colectomy are limited. The aim of this study was to investigate the role of different bowel preparation strategies in patients undergoing open, minimally invasive, and converted-to-open elective colectomies.

METHODS

We identified 39,355 patients who underwent elective colectomy from the American College of Surgeons National Surgical Quality Improvement Program colectomy-targeted database (2012-2016). Multivariate logistic regression models were used to assess the impact of different bowel preparation strategies on postoperative complications and mortality in three subapproach groups: open (n = 12,141), minimally invasive (n = 23,057), and converted to open (n = 4157).

RESULTS

Overall, a total of 10,066 (25.6%) patients received no preparation (NP), 11,646 (29.5%) mechanical bowel preparation (MBP) alone, 1664 (4.2%) antibiotic bowel preparation (ABP) alone, and 15,979 (40.6%) MBP + ABP. Compared with NP, MBP + ABP showed the strongest protective effects. MBP + ABP was associated with reduced risk of major complications (odds ratio [OR] = 0.60, 95% confidence interval [CI]: 0.55-0.66), infectious complications (OR = 0.50, 95% CI: 0.46-0.54), any complications (OR = 0.55, 95% CI: 0.51-0.60), 30-d mortality (OR = 0.68, 95% CI: 0.48-0.96), anastomotic leak (OR = 0.50, 95% CI: 0.43-0.58), and length of stay ≥ 4 d (OR = 0.64, 95% CI: 0.61-0.67) in overall population. These protective effects, except for 30-d mortality, were observed in open, minimally invasive, and converted-to-open groups. When the analysis was limited to robotic surgery only, MBP + ABP was only associated with reduced risk of major complications (OR = 0.61, 95% CI: 0.38-0.97) compared with NP. The protective effects remained similar over the study time period.

CONCLUSIONS

MBP + ABP is a preferred preoperative strategy in open, minimally invasive, and converted-to-open colectomy.

摘要

背景

结直肠切除术前的肠道准备被认为是降低术后并发症的有效策略。然而，关于微创结直肠切除术中肠道准备效果的数据有限。本研究旨在探讨不同肠道准备策略在开腹、微创和转为开腹择期结直肠切除术中的作用。

方法

我们从美国外科医师学会国家手术质量改进计划结直肠靶向数据库（2012-2016 年）中确定了 39355 例接受择期结直肠切除术的患者。多变量逻辑回归模型用于评估三种不同入路组（开腹组[n=12141]、微创组[n=23057]和转为开腹组[n=4157]）中不同肠道准备策略对术后并发症和死亡率的影响。

结果

总体而言，共有 10066 例（25.6%）患者未接受准备（NP），11646 例（29.5%）单独接受机械肠道准备（MBP），1664 例（4.2%）单独接受抗生素肠道准备（ABP），15979 例（40.6%）接受 MBP+ABP。与 NP 相比，MBP+ABP 显示出最强的保护作用。MBP+ABP 与降低主要并发症风险相关（比值比[OR] = 0.60，95%置信区间[CI]：0.55-0.66）、感染性并发症（OR = 0.50，95%CI：0.46-0.54）、任何并发症（OR = 0.55，95%CI：0.51-0.60）、30 天死亡率（OR = 0.68，95%CI：0.48-0.96）、吻合口漏（OR = 0.50，95%CI：0.43-0.58）和住院时间≥4 天（OR = 0.64，95%CI：0.61-0.67）。这些保护作用除 30 天死亡率外，在开腹、微创和转为开腹组中均观察到。当分析仅限于机器人手术时，与 NP 相比，MBP+ABP 仅与降低主要并发症风险相关（OR = 0.61，95%CI：0.38-0.97）。研究期间保护作用相似。