Lyu Z J, Liang W J, Lin Z B, Zhang G R, Wu D Q, Luo Y W, Yan Q, Cai G F, Yao X Q, Li Y
Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510060, China.
Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510060, China; Medical College of Shantou University, Shantou, Guangdong 515000, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2020 Jun 25;23(6):578-583. doi: 10.3760/cma.j.cn.441530-20190611-00238.
To understand the current practice of preoperative bowel preparation in elective colorectal surgery in China. A cross-sectional questionnaire survey was conducted through wechat. The content of the questionnaire survey included professional title of the participants, the hospital class, dietary preparation and protocol, oral laxatives and specific types, oral antibiotics, gastric intubation, and mechanical enema before elective colorectal surgery. A stratified analysis based on hospital class was conducted to understand their current practice of preoperative bowel preparation in elective colorectal surgery. A total of 600 questionnaires were issued, and 516 (86.00%) questionnaires of participants from different hospitals, engaged in colorectal surgery or general surgeons were recovered, of which 366 were from tertiary hospitals (70.93%) and 150 from secondary hospitals (29.07%). For diet preparation, the proportions of right hemicolic, left hemicolic and rectal surgery were 81.59% (421/516), 84.88% (438/516) and 84.88% (438/516) respectively. The average time of preoperative dietary preparation was 2.03 days. The study showed that 85.85% (443/516) of surgeons chose oral laxatives for bowel preparation in all colorectal surgery, while only 4.26% (22/516) of surgeons did not choose oral laxatives. For mechanical enema, the proportions of right hemicolic, left hemicolic and rectal surgery were 19.19% (99/516), 30.04% (155/516) and 32.75% (169/516) respectively. Preoperative oral antibiotics was used by 34.69% (179/516) of the respondents. 94.38% (487/516) of participants were satisfied with bowel preparation, and 55.43% (286/516) of participants believed that preoperative bowel preparation was well tolerated. In terms of preoperative oral laxatives, there was no statistically significant difference between different levels of hospitals [secondary hospitals vs. tertiary hospitals: 90.00% (135/150) vs. 84.15% (308/366), χ(2)=2.995, =0.084]. Compared with the tertiary hospitals, the surgeons in the secondary hospitals accounted for higher proportions in diet preparation [87.33% (131/150) vs. 76.78% (281/366), χ(2)=7.369, =0.007], gastric intubation [54.00% (81/150) vs. 36.33% (133/366), χ(2)=13.672, <0.001], preoperative oral antibiotics [58.67% (88/150) vs. 24.86% (91/366), χ(2)=12.259, <0.001] and enema [28.67% (43/150) vs. 15.30% (56/366), χ(2)=53.661, <0.001]. Although the preoperative bowel preparation practice in elective colorectal surgery for most of surgeons in China is basically the same as the current international protocol, the proportions of mechanical enema and gastric intubation before surgery are still relatively high.
为了解中国择期结直肠手术术前肠道准备的现状。通过微信进行了一项横断面问卷调查。问卷调查内容包括参与者的职称、医院等级、饮食准备及方案、口服泻药及具体类型、口服抗生素、胃管置入以及择期结直肠手术前的机械灌肠。基于医院等级进行分层分析,以了解他们在择期结直肠手术术前肠道准备的现状。共发放问卷600份,回收来自不同医院从事结直肠手术或普通外科的参与者问卷516份(86.00%),其中来自三级医院366份(70.93%),二级医院150份(29.07%)。对于饮食准备,右半结肠、左半结肠和直肠手术的比例分别为81.59%(421/516)、84.88%(438/516)和84.88%(438/516)。术前饮食准备的平均时间为2.03天。研究表明,85.85%(443/516)的外科医生在所有结直肠手术中选择口服泻药进行肠道准备,而只有4.26%(22/516)的外科医生不选择口服泻药。对于机械灌肠,右半结肠、左半结肠和直肠手术的比例分别为19.19%(99/516)、30.04%(155/516)和32.75%(169/516)。34.69%(179/516)的受访者术前使用口服抗生素。94.38%(487/516)的参与者对肠道准备满意,55.43%(286/516)的参与者认为术前肠道准备耐受性良好。在术前口服泻药方面,不同级别医院之间无统计学差异[二级医院与三级医院:90.00%(135/150)对84.15%(308/366),χ²=2.995,P=0.084]。与三级医院相比,二级医院的外科医生在饮食准备[87.33%(131/150)对76.78%(281/366),χ²=7.369,P=0.007]及胃管置入[54.00%(81/150)对36.33%(133/366),χ²=13.672,P<0.001]、术前口服抗生素[58.67%(88/150)对24.86%(91/366),χ²=12.259,P<0.001]和灌肠[28.67%(43/150)对15.30%(56/366),χ²=5.3661,P<0.001]方面所占比例更高。尽管中国大多数外科医生在择期结直肠手术中的术前肠道准备做法基本与当前国际方案一致,但术前机械灌肠和胃管置入的比例仍然相对较高。