无机械性肠道准备对妇科良性疾病腹腔镜手术影响的研究

Study on the effect of no mechanical bowel preparation on laparoscopic surgery of gynecological benign diseases

目的:综合比较术前口服甘露醇、密闭式灌肠与无肠道准备对妇科良性疾病腹腔镜手术的手术视野、肠管可控性、患者满意度、术后并发症、住院天数等方面的影响。方法:采用前瞻性随机单盲对照研究,选取2019年2月至2019年10月在中国医科大学附属盛京医院接受腹腔镜手术的306例妇科良性疾病患者。将患者随机分为3组口服甘露醇组(101例),密闭式灌肠组(102例),无肠道准备组(103例)。术者及实验指标观察者始终处于盲态。术野暴露满意度、肠管可控性、患者满意度等主观指标使用视觉模拟评分法(VAS)评估。术前观察指标包括患者对肠道准备的满意度及肠道准备伴随的不良症状,术中观察指标包括手术视野的满意度、肠管可控性、手术时间、术中出血量,术后恢复观察指标包括术后首次排气时间、是否感染、是否形成静脉血栓、是否出现肠道并发症、血清离子及血红蛋白变化、住院天数、住院费用。结果:3组患者的肠道准备满意度比较,差异有统计学意义(P<0.05),无肠道准备组的满意度高于口服甘露醇组和密闭式灌肠组。口服甘露醇组和密闭式灌肠组患者出现难以服用灌肠剂、腹胀、呕吐、乏力、睡眠质量下降等不良反应。无肠道准备组患者仅出现睡眠质量下降,无其他不适症状出现,且不适症状的比例低于口服甘露醇组和密闭式灌肠组。3组患者手术视野暴露满意程度等术中观察指标无明显差异(P<0.05)。术后恢复观察指标,3组患者术后首次排气时间比较,存在差异(P<0.05),无肠道准备组患者术后首次排气时间较口服甘露醇组和密闭式灌肠组略短,其他术后观察指标,如感染、肠道并发症、静脉血栓形成等,均无统计学差异(P>0.05)。结论:妇科良性疾病腹腔镜术前机械性肠道准备对于手术过程并无益处,并且易引起患者不适症状,延长术后首次排气时间,降低患者满意度。因此,妇科良性疾病腹腔镜术前不必常规行机械性肠道准备。

Objective:The effects of preoperative oral mannitol,closed enema and no intestinal preparation for gynecologic benign diseases of laparoscopic on the surgical field,bowel controllability,patient satisfaction,postoperative complications,hospitalization days and so on were synthetically compared.Methods:The prospective randomized single blind control study was used.From Feb.2019 to Oct.2019,patients with gynecological benign diseases undergoing laparoscopic surgery in Shengjing Hospital of China Medical University were randomly divided into three groups:group A(n=101):oral Mannitol,group B(n=102):closed enema,group C(n=103):no mechanical bowel preparation.The operator and the experimental indexes observer were always in a blind state.Visual analog scales were used to evaluate the subjective indexes such as surgical visualization,bowel controllability and patient satisfaction.Preoperative observation indexes included patient satisfaction with bowel preparation and associated adverse symptoms.Intraoperative observation indexes included satisfaction with surgical visualization,bowel controllability,operation time and intraoperative bleeding volume.Postoperative recovery observation indexes included first postoperative exhaust time,postoperative infection,vein thrombosis,bowel complications,serum ions and hemoglobin changes,length of stay and hospitalization expenses.Results:There was significant difference in the satisfaction of bowel preparation among the three groups(P<0.05),group C was higher than that in group A and group B.The patients in group A and B had adverse symptoms such as difficulty in taking enema,abdominal distention,vomiting,fatigue and poor sleep quality,while the patients in group C only had sleep quality decline without other discomfort symptoms,and the proportion was lower than that in group A and B.There was no significant difference in surgical visualization among the three groups(P<0.05).The first postoperative exhaust time of postoperative recocery observation indexes,there was a significant difference among the three groups(P<0.05).The first postoperative exhaust time of group C was slightly shorter than that of group A and group B.The other postoperative indexes was no significant difference(P>0.05),such as infection,intestianl complications,venous thrombosis,etc.Conclusions:Mechanical bowel preparation before laparoscopic surgery for gynecological benign diseases is not beneficial to the operation process,while it is easy to cause uncomfortable symptoms,prolong the first postoperative exhaust time,and reduce patient satisfaction.Therefore,Mechanical bowel preparation is not necessary before laparoscopic surgery for gynecological benign diseases.