术前肠道准备影响结直肠癌根治术预后的研究进展

Preoperative bowel preparation affects the prognosis of colorectal cancer after radical surgery: a systemic review

术前肠道准备(PBP)是结直肠癌(CRC)根治性切除手术的必要术前准备,既往主要采取传统肠道准备(TBP)如清洁灌肠,但是存在较大风险,容易引起患者营养状况下降、水电解质紊乱、肠壁充血和水肿,甚至导致肠道内癌细胞脱落,增加局部复发(LR)和远处转移(DM)的风险。而目前临床实践主要应用术前快速肠道准备法(RBP),其优点在于操作简便、对肠道损伤较小且患者耐受性好,但是由于RBP采用的口服泻药如口服甘露醇的患者在手术中因甘露醇可被分解产生甲烷,因而禁用电刀、电凝,影响术中止血。近期国内外学者提出术前肠内营养(EN)代替术前TBP或RBP,在避免上述两者缺点的同时能够改善患者营养状况,更快地促进术后肠道功能恢复,且不会增加术后感染等并发症。本文就PBP相关处理措施的优缺点以及对CRC患者近、远期预后影响研究最新进展进行综述。

Preoperative bowel preparation（PBP） for colorectal cancer（CRC） radical surgery（RS） is necessary and has been widely used in clinical practice. The previously adopted traditional bowel preparation（TBP） is associated with substantial complications such as intestinal congestion, water-electrolyte imbalance, reduced nutritional status, hyperemia and edema, and even leading to increased local recurrence（LR） and distant metastasis（DM） due to repeated stimulation of tumors. The current mainly clinical practice is fast preoperative bowel preparation（RBP）, due to its convenient performance, good tolerance and less damage to the intestinal tract. But the laxatives of RBP through oral administration, decomposed to methane, which might result in forbidding the use of electric knife or electric coagulation, reduce the operation of hemostasis. Recently, some scholars suggest preoperative enteral nutrition（EN） for bowel preparation before surgery, which can improve patients nutritional status, promote postoperative recovery of intestinal function and do not increase postoperative complications such as infection. Here, we review the medical literature related to PBP for colorectal cancer patients before radical surgery, with highlights on their advantages, shortcomings, and their influence of short-and long-term outcomes.