肠内营养用于术前肠道准备对结直肠癌患者腹腔和肠腔脱落癌细胞的影响

Effect of Enteral Nutrition Replacing Traditional Gut Preparation on the Intraperitoneal and Intraluminal Disseminated Tumor Cells in Patients with Colorectal Cancer

目的探讨术前肠内营养代替肠道准备对结直肠癌患者腹腔和肠腔脱落癌细胞的影响。方法将经病理确诊的60例结直肠癌患者随机分为两组,每组30人:A组于术前3天起每日口服30ml/kg瑞素,不进行灌肠,不口服泻药和抗生素;B组采用传统肠道准备,包括术前禁食、口服抗生素和清洁灌肠。两组患者均在开腹后用400ml生理盐水冲洗肿瘤所在的局部腹腔,抽取腹腔冲洗液200ml,迅速送检;手术切除肿瘤后作肠吻合之前,用1000ml生理盐水灌洗远端结直肠腔,收集肠腔冲洗液500ml,迅速送检。比较两组患者腹腔和肠腔内脱落的癌细胞阳性率,同时比较其肠道清洁度、术后肛门排气恢复时间和并发症发生率。结果A组患者腹腔和肠腔内脱落癌细胞阳性率分别为3.3%(1/30)和6.7%(2/30),明显低于B组患者的20.0%(6/30)和26.8%(8/30)(P均<0.05)。两组患者的肠道清洁度、术后肛门排气恢复时间和并发症发生率差异均无显著性(P均>0.05)。结论术前肠内营养可减少结直肠癌患者腹腔和肠腔脱落癌细胞的阳性率。

Objective To explore the effect of enteral nutrition replacing traditional gut preparation on the intraperitoneal and intraluminal disseminated tumor cells in the patients with colorectal cancer. Methods We divided 60 patients with pathologically confirmed colorectal cancer into two group ： Group A （ n = 30 ） received preoperative gut preparation with Fresubin~ （ 30 ml· kg^-1·d^-1 ） and without washing gut or taking medicine ; group B （ n = 30 ） underwent traditional preoperative intestinal preparation, including fasting, oral administration of antibiotics, and enema cleaning for consecutively 3 days. All patients underwent peritoneal lavage with 400 ml normal saline when peritoneal cavity opened, and 200 ml lavage fluid was collected for each patient. All patients were given distal colorectal lavage with 1 000 ml normal saline before anastomosis, and 500 ml lavage fluid was collected for each patient. Exfoliative cytological examination was performed for each sample. The residual intestinal feces during operation, postoperative complications, anastomtic leakage, and intestinal function recovery time were recorded. Results Cancer cells in peritoneal lavage fluid were found in 1 patient in group A （ 1/30, 3.3% ） and in 6 patients （6/30, 20.0% ） in group B （P 〈 0. 05）. Cancer cells in distal colorectal lavage fluid were found in 2 patients （2/30, 6. 7% ） in group A and 8 patients （8/30, 26. 8% ） in group B （P 〈 0. 05 ）. Condusion Enteral nutrition replacing traditional bowel preparation may decrease the positive rate of disseminated cancer cells in peritoneal cavity or colorectal lumen in patients with colorectal carcinoma without affecting postoperative complications and intestinal function.