Panton O N, Atkinson K G, Crichton E P, Schulzer M, Beaufoy A, Germann E
Am J Surg. 1985 May;149(5):615-9. doi: 10.1016/s0002-9610(85)80139-2.
In this prospective, randomized study, 121 elective colorectal surgery patients had whole-gut lavage (n = 67) or enemas and purgatives (n = 54). Patient characteristics were well matched. Intravenous metronidazole and tobramycin were administered preoperatively initially in 53 patients, with the remaining 68 patients receiving the drugs perioperatively. Bowel preparation was satisfactory (minimal or no contents remaining) in 92.8 percent of patients with whole-gut lavage and 92.6 percent with enemas and purgatives (p = 0.72). Nasogastric tube insertion was poorly tolerated by 39 percent of the patients receiving whole-gut lavage, and enema tube insertion by 23 percent with enemas and purgatives. Fluid infusion tolerance was similar with both techniques. Abdominal wound sepsis occurred in 22 patients (18.8 percent), being unrelated to mechanical preparation or antimicrobial prophylaxis (p = 0.19). Colostomy closure was associated with a 42.8 percent sepsis rate. Excluding this group, wound sepsis with the remaining procedures was 13 percent (statistically significant, p = 0.03). Other complications included intraabdominal abscesses (3.3 percent), anastomotic leaks (2.5 percent), eviscerations (1.6 percent), and an operative mortality of 1.6 percent. We have concluded that whole-gut lavage and enemas and purgatives are equally efficacious mechanically with similar associated wound sepsis rates.
在这项前瞻性随机研究中，121例择期结直肠手术患者接受了全肠道灌洗（n = 67）或灌肠及泻药治疗（n = 54）。患者特征匹配良好。最初，53例患者术前静脉给予甲硝唑和妥布霉素，其余68例患者围手术期给予这些药物。全肠道灌洗组92.8%的患者肠道准备满意（残留内容物极少或无残留），灌肠及泻药组为92.6%（p = 0.72）。接受全肠道灌洗的患者中39%对鼻胃管插入耐受性差，接受灌肠及泻药治疗的患者中23%对灌肠管插入耐受性差。两种技术的液体输注耐受性相似。22例患者（18.8%）发生腹部伤口感染，与机械性肠道准备或抗菌药物预防无关（p = 0.19）。结肠造口关闭术的感染率为42.8%。排除该组后，其余手术的伤口感染率为13%（具有统计学意义，p = 0.03）。其他并发症包括腹腔内脓肿（3.3%）、吻合口漏（2.5%）、脏器脱出（1.6%），手术死亡率为1.6%。我们得出结论，全肠道灌洗与灌肠及泻药在机械性肠道准备方面同样有效，且相关伤口感染率相似。
