Ambrose N S, Keighley M R
Ann R Coll Surg Engl. 1986 Jan;68(1):34-6.
The removal of solid and liquid faeces from the colon is a prerequisite for safe colonic resection. Previous studies attempting to quantify evacuation of the colon have relied on a subjective opinion on isolated areas of the colon at the time of surgery. In an attempt to validate the surgeon's opinion, we have studied the efficiency of bowel preparation in 55 patients undergoing elective surgery requiring bowel preparation. Efficiency of bowel preparation has been assessed by (i) the subjective evaluation of the operating surgeon, (ii) the weight of faecal residue in the resected colon, and (iii) the production of a 'granule index' based upon the removal of Portex granules from the colon by preparation as measured on plain abdominal X-rays before and after preparation. The correlation between weighed faecal residue and the subjective assessment was poor. In 7 of 20 patients assessed subjectively as having no residue, faecal loading was in excess of more than 0.1 g/cm. The surgical assessment did not correlate with the clearance of Portex granules and two patients who had complete clearance of granules were judged poorly prepared. Surgeons are generally poor judges at assessing success or failure of bowel preparation. Standardisation of success of bowel preparation is important in the comparison of clinical trials and Portex granules would appear to give an accurate preoperative assessment of the efficiency of bowel preparation.
从结肠清除固体和液体粪便，是安全进行结肠切除术的前提条件。以往试图对结肠排空进行量化的研究，依赖于手术时对结肠孤立区域的主观判断。为了验证外科医生的判断，我们对55例接受需要肠道准备的择期手术患者的肠道准备效果进行了研究。肠道准备效果通过以下方式评估：（i）手术医生的主观评估；（ii）切除结肠中粪便残渣的重量；（iii）根据准备前后腹部平片测量的结肠中通过准备清除的波泰克斯颗粒产生“颗粒指数”。称重的粪便残渣与主观评估之间的相关性较差。在20例主观评估无残渣的患者中，有7例粪便负荷超过0.1 g/cm。手术评估与波泰克斯颗粒清除情况不相关，两名颗粒完全清除的患者被判定肠道准备不佳。外科医生在评估肠道准备的成败方面通常判断能力较差。在比较临床试验时，肠道准备成功的标准化很重要，波泰克斯颗粒似乎能对肠道准备效果进行准确的术前评估。
