Sassani Jessica C, Kantartzis Kelly, Wu Liwen, Fabio Anthony, Zyczynski Halina M
Division of Urogynecology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA, 15218, USA.
Banner University Medical Center, University of Arizona, Phoenix, AZ, USA.
Int Urogynecol J. 2020 Jul;31(7):1305-1313. doi: 10.1007/s00192-019-04120-7. Epub 2019 Nov 26.
The objective was to determine if a bowel preparation prior to minimally invasive sacrocolpopexy (MIS) influences post-operative constipation symptoms. We hypothesized that women who underwent a bowel preparation would have an improvement in post-operative defecatory function.
In this randomized controlled trial, women undergoing MIS received a pre-operative bowel preparation or no bowel preparation. Our primary outcome was post-operative constipation measured by the Patient Assessment of Constipation Symptoms (PAC-SYM) 2 weeks post-operatively. Secondary outcomes included surgeon's perception of case difficulty. Both intention-to-treat (ITT) and per-protocol analyses (PPA) were performed. Analyses were carried out using t test, Fisher's exact test, the Wilcoxon test and the Chi-squared test.
Of 105 enrolled women, 95 completed follow-up (43 preparation and 52 no preparation). Baseline characteristics and rates of complications were similar. No differences were noted on ITT. The post-operative abdominal PAC-SYM subscale was closer to baseline for women who received a bowel preparation on PPA (change in score 0.74 vs 1.08, p = 0.045). Women who underwent a preparation were less likely to report strain (6.0% vs 26.7%, p = 0.009) or type 1 Bristol stool on their first post-operative bowel movement (4.3% vs 17.5%, p = 0.047). Surgeons were more likely to rate the complexity of the case as "more difficult than average" (54.4% vs 40.1%, p = 0.027) in those without a bowel preparation.
Although there was no difference in ITT analysis, women who underwent a bowel preparation prior to MIS demonstrated benefit to post-operative defecatory function with a corresponding improvement in surgeon's perception of case complexity.
目的是确定微创骶骨阴道固定术（MIS）前的肠道准备是否会影响术后便秘症状。我们假设接受肠道准备的女性术后排便功能会有所改善。
在这项随机对照试验中，接受MIS的女性接受术前肠道准备或不进行肠道准备。我们的主要结局是术后2周通过患者便秘症状评估（PAC-SYM）测量的术后便秘情况。次要结局包括外科医生对病例难度的感知。进行了意向性分析（ITT）和符合方案分析（PPA）。使用t检验、Fisher精确检验、Wilcoxon检验和卡方检验进行分析。
105名入组女性中，95名完成随访（43名接受准备，52名未接受准备）。基线特征和并发症发生率相似。ITT分析未发现差异。在PPA中，接受肠道准备的女性术后腹部PAC-SYM子量表更接近基线（得分变化0.74对1.08，p = 0.045）。接受准备的女性术后首次排便时报告用力排便的可能性较小（6.0%对26.7%，p = 0.009）或布里斯托大便分类法1型大便的可能性较小（4.3%对17.5%，p = 0.047）。在未进行肠道准备的患者中，外科医生将病例复杂性评为“比平均水平更困难”的可能性更高（54.4%对40.1%，p = 0.027）。
尽管ITT分析没有差异，但在MIS前接受肠道准备的女性术后排便功能有改善，同时外科医生对病例复杂性的感知也相应改善。
