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中华普外科手术学杂志(电子版)

中华普外科手术学杂志(电子版) ›› 2020, Vol. 14 ›› Issue (05) : 464 -467. doi: 10.3877/cma.j.issn.1674-3946.2020.05.011

所属专题： 文献；

论著

机械性肠道准备在结直肠手术的临床应用价值研究
李肆柱1, 贾恒1,†(), 张溪1, 訾维1, 王文刚1, 孙鹏进1, 杨威1   
  1. 1. 710021　陕西，西安市中医医院
  • 收稿日期:2019-11-19 出版日期:2020-10-26
  • 通信作者: 贾恒

Clinical evaluation of mechanical bowel preparation in preoperative management of colorectal cancer

Sizhu Li1, Heng Jia1,†(), Xi Zhang1, Wei Zi1, Wengang Wang1, Pengjin Sun1, Wei Yang1   

  1. 1. Xi’an Traditional Chinese Medicine Hospital, Shaanxi 710021, China
  • Received:2019-11-19 Published:2020-10-26
  • Corresponding author: Heng Jia
  • About author:
    Corresponding author: Jia Heng, Email:
  • Supported by:
    Key Project, of Shaanxi Provincial Social Development Program(2018SF062)
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李肆柱, 贾恒, 张溪, 訾维, 王文刚, 孙鹏进, 杨威. 机械性肠道准备在结直肠手术的临床应用价值研究[J]. 中华普外科手术学杂志(电子版), 2020, 14(05): 464-467.

Sizhu Li, Heng Jia, Xi Zhang, Wei Zi, Wengang Wang, Pengjin Sun, Wei Yang. Clinical evaluation of mechanical bowel preparation in preoperative management of colorectal cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2020, 14(05): 464-467.

目的

探究机械性肠道准备(MBP)在结直肠手术中的临床应用价值。

方法

前瞻性选取2017年5至2019年6月104例结直肠癌手术患者进行研究。根据数字随机法将患者随机分为MBP组(术前行MBP)和非MBP组(术前不行MBP)各52例。手术操作均由同一医师团队完成，两组患者均行开腹结直肠癌根治术。采用统计软件SPSS 20.0进行分析，围术期各项指标、应激反应指标、肠道菌群变化指标等采用(±s)表示，组间行独立t检验；术后并发症行卡方检验，P<0.05为检验标准。

结果

非MBP组术后首次排气时间及住院时间优于MBP组(P<0.05)，两组术后并发症总发生率差异无统计学意义(P>0.05)；术后1 d、3 d两组Cor、hs-CRP、IL-6等应激指标水平较术前显著升高(P<0.05)，MBP组显著高于非MBP组(P<0.05)。较术前相比，术后两组均出现轻至中度肠道菌群失调，非MBP组Ⅱ、Ⅲ度菌群失调程度轻于MBP组(P＝0.011)。术后两组益生菌BL、LC计数较术前明显降低，非MBP组高于MBP组(P<0.05)；致病菌EB、SP计数较术前明显升高，非MBP组低于MBP组(P<0.05)。

结论

结直肠手术术前行MBP可加重患者应激反应及肠道菌群失调程度，不能降低术后感染及吻合口漏等并发症的发生，其整体临床应用价值呈现弊大于利，术前不建议行MBP。

关键词: 结直肠肿瘤, 结直肠外科手术, 机械性肠道准备, 应用价值
Objective

To explore the clinical value of mechanical bowel preparation (MBP) in preoperative management of colorectal cancer.

Methods

Prospective study were carried out from May 2017 to June 2019, including 104 patients with colorectal cancers. According to the numerical randomization method, 104 patients were randomly divided into MBP group (52 cases with preoperative MBP) and non-MBP group (52 cases without preoperative MBP). Patients in both groups underwent laparotomy for colorectal cancer by the same surgeon. Statistical analysis were performed by using SPSS 20.0 software. Measurement data such as perioperative indicators, stress response indicators and changes in intestinal flora were expressed as (±s) and were examined by using independent t test. Postoperative complications.were analyzed by using Chi-square test. A P value <0.05 was considered as statistically significant.

Results

The first postoperative exhaust time and hospitalization time in the non-MBP group were better than those in the MBP group (P<0.05). There was no significant difference of overall incidence of postoperative complications between the two groups (P>0.05). Cor, hs-crp, il-6 and other stress indicators in the two groups were significantly increased on day 1 and day 3 after the operation compared with those before the operation respectively (P<0.05), however with significantly higher level in the MBP group than that in the non-MBP group (P<0.05). In both two groups postoperative mild to moderate intestinal flora imbalance were all observed, and Ⅱ, Ⅲ dysbacteriosis degree in the MBP group is lighter than that in the MBP group (P=0.011). BL and LC count of probiotics in the two groups was significantly lower than those before surgery, and that in the non-MBP group was higher than that in the MBP group (P<0.05). The number of EB and SP of pathogenic bacteria was significantly higher than those before operation, with lower level in non-MBP group than that in MBP group (P<0.05).

Conclusion

MBP before colorectal surgery could aggravate patients’ stress response and intestinal flora imbalance, however has no significant impact on reducing the incidence of postoperative infection, anastomotic fistula and other complications. Its overall clinical application value is more harmful than beneficial, and MBP before surgery is not safe and feasible.

Key words: Colorectal neoplasms, Colorectal surgery, Mechanical bowel preparation, Application value
表1 104例结直肠癌患者不同术前准备方法两组患者一般基线资料比较[(±s)，例]
组别 例数 年龄(岁) 性别 TNM分期 ASA分级
男/女 Ⅱ/Ⅲ/Ⅳ Ⅰ/Ⅱ/Ⅲ
MBP组 52 57.4±10.5 30/22 22/26/4 2/31/19
非MBP组 52 55.7±11.8 28/24 20/27/5 3/26/23
t/χ2/Z - 0.776 0.1566 -0.458 -0.113
P - 0.220 0.0693 0.647 0.910
组别 例数 肿瘤部位 吻合方式 合并症
A/B/C/D E/F/G H/I/J
MBP组 52 11/5/26/10 11/17/24 7/1/6
非MBP组 52 10/4/24/14 13/14/25 5/2/8
t/χ2/Z - 0.905 0.477 0.919
P - 0.824 0.788 0.632
表2 104例结直肠癌患者不同术前准备方法两组患者围术期指标对比(±s)
组别 术时(min) 出血量(ml) 首次排气时间(d) 住院时间(d)
MBP组 109.4±35.7 103.2±20.4 3.5±1.0 13.4±1.3
非MBP组 113.5±31.6 105.4±17.2 3.2±0.8 12.9±1.4
t 0.620 0.595 1.689 1.887
P 0.268 0.277 0.047 0.031
表3 104例结直肠癌手术患者不同术前准备方法两组术后并发症情况对比(例)
组别 例 腹泻 腹腔感染/脓肿 吻合口漏 切口感染 早期肠梗阻 总并发率
MBP组 52 4 3 1 3 0 10(19.2)
非MBP组 52 3 1 2 2 1 8(15.4)
χ2 - ? ? ? ? ? 0.269
P - ? ? ? ? ? 0.604
表4 104例结直肠癌患者不同术前准备方法两组患者手术前后应激反应指标变化情况(±s)
组别 例 时间点 Cor(μg/L) hs-CRP(mg/L) IL-6(ng/L)
MBP组 52 术前3 d 170.4±31.8 0.8±0.4 3.7±1.3
? ? 术后1 d 358.3±37.9ab 9.4±1.4ab 8.9±2.2ab
? ? 术后3 d 338.6±32.7ab 8.5±1.7ab 7.5±1.5ab
非MBP组 52 术前3 d 172.1±30.3 0.8±0.3 3.6±1.5
? ? 术后1 d 246.8±35.4a 5.8±0.8a 5.3±1.7a
? ? 术后3 d 230.4±30.2a 5.2±0.6a 5.2±1.3a
表5 104例结直肠癌患者不同术前准备方法两组患者肠道菌群失调分度情况比较(例，度)
组别 例 术前 术后
Ⅰ/Ⅱ/Ⅲ Ⅰ/Ⅱ/Ⅲ
MBP组 52 27/18/7 8/33/11
非MBP组 52 25/17/10 17/31/4
Z - -0.588 -2.541
P - 0.557 0.011
表6 104例结直肠癌患者不同术前准备方法两组患者手术前后肠道菌群计数比较[Log10n/g, (±s)]
组别 时间点 BL LC EB SP
MBP组 术前 6.4±2.8 5.9±2.6 8.4±0.8 6.7±1.1
? 术后 3.5±2.5a 2.9±2.1a 10.3±1.1a 8.1±1.1a
非MBP组 术前 6.5±2.4 5.9±2.4 8.4±0.8 6.7±1.0
? 术后 5.7±2.2 4.5±1.5 8.8±0.7 6.9±0.9
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