择期结肠癌术前机械性肠道准备的研究

Research of preoperatie mechanical bowel preparation before colon cancer

目的评估择期结肠癌手术前无机械性肠道准备的安全性和有益性。方法对照组采用回顾性研究,回顾2010年1月-2014年12月间我科结肠癌手术患者42例,常规行机械性肠道准备(MBP);研究组采用前瞻性研究,选取2015年1月-2016年12月间42例患者不行机械性肠道准备(NMBP),术后比较两组患者感染指标:切口感染、腹腔脓肿、吻合口漏发生率;肠功能恢复指标:首次肛门排气时间、开始半流饮食时间及术后第一次大便中益生菌双岐杆菌和乳酸杆菌的数量。结果两组切口感染率和吻合口瘘的发生率相比无显著差异(P>0.05);术后腹腔脓肿发生率相比有显著差异(P<0.05),MBP组大于NMBP组。术后首次肛门排气时间和开始半流饮食时间比较,两组均有显著差异(P<0.05),MBP组大于NMBP组。术后比较肠道益生菌双歧杆菌和乳酸杆菌,两组均有显著差异(P<0.05),MBP组小于NMBP组。结论 NMBP不会升高切口感染率和吻合口瘘的发生率,但可以降低腹腔脓肿的发生率。NMBP可以使患者术后更早排气排便,更早进食。NMBP术后对肠道菌群影响小恢复快,利于肠功能恢复。所以,择期结肠癌术前无机械性肠道准备是安全有益的。

Objective To evaluate the safety and Benefity of preoperative and non-mechanical bowel preparation before elective colon cancer surgery. Methods A retrospective study was performed to review 42 cases of colon cancer patients between January 2010 and December 2014, the mechanical bowel preparation（MBP） was treated as the control group. 42 patients with no mechanical intestinal preparation（NMBP） from January 2015 to December 2016 was treated as the study group. After the operation, the index of infection in the two groups was compared： first anus exhaust time, start a half-flow diet, the number of bifidobacteria and Lactobacillus probiotics in the first post operation stool. Results There was no significant difference in the rate of infection between the two groups and the incidence of anastomotic fistula（P〈0.05）, There was a significant difference in the incidence of postoperative abdominal abscess（P〈0.05）, and group MBP was greater than that in group NMBP. There were significant differences between the two groups（P〈0.05）. About the first exhaust time and the beginning of the half flow diet, MBP group were larger than NMBP group. After the operation, about the intestinal probiotics Bifidobacterium and lactobacillus, MBP group was less than group NMBP（P〈0.05）. Conclusion NMBP can not increase the incidence of incisional infection and anastomotic fistula and can reduce the incidence of abdominal abscess. NMBP can enable the patient to exhaust and defecate earlier and eat earlier. The effect of NMBP on intestinal microflora was fast, and it is beneficial to the recovery of intestinal function. It is safe and beneficial.