术前未行肠道准备对择期结直肠手术影响的探讨

Influence of unprepared bowel procedures on elective colorectal surgery

目的探讨术前不做肠道准备对择期结直肠手术的影响。方法回顾性分析成都市第三人民医院2015年1月至2017年12月间73例择期行结直肠肿瘤手术且保肛未行造口患者,分为进行肠道准备的传统组(35例)和未行肠道准备的改进组(38例),由同组人员进行择期手术。观察比较两组患者围手术期情况以及术后并发症发生情况。结果两组患者在术前1 d时CRP、CD4/CD8、IL-6、血糖和血清白蛋白水平比较,差异无统计学意义;两组患者手术时间、术中出血量、术后首次肛门排气排便时间,以及肺部感染、吻合口漏、SSI、肠梗阻等术后并发症发生比较,差异无统计学意义;传统组患者在术后24 h、3 d的CRP、IL-6、血糖和血清白蛋白水平以及术后24 h的CD4/CD8明显高于同期改进组(P<0.05)。结论术前未行肠道准备能降低结直肠手术患者的应激反应,加速术后快速康复,且不明显增加并发症,但仍需科学规范地评估术前是否行肠道准备。

Objective To explore the effect of elective colorectal surgery without preoperative bowel preparation.Methods From January 2015 to December 2017,73 cases in Chengdu Third People’s Hospital undergoing elective colorectal tumor surgery without fistula were retrospectively analyzed.They were divided into conventional group(35 cases)and improved group(38 cases,without bowel preparation).The perioperative conditions and complications of the two groups were observed and compared.Results There were no significant differences in CRP,CD4/CD8,IL-6,blood glucose and serum albumin levels between the two groups 1 day before operation.There were no significant differences in operation time,intraoperative blood loss,first anal exhaust and defecation time,pulmonary infection,anastomotic leakage,SSI,intestinal obstruction and other postoperative complications between the two groups.The levels of CRP,IL-6,blood glucose and serum albumin in the conventional group were significantly higher than those in the improved group at 24 h and 3 d after operation(P<0.05).Conclusions Non preoperative bowel preparation can reduce the stress response of patients undergoing colorectal surgery,accelerate the rapid recovery after surgery,and does not increase the complications significantly.However,it is still necessary to evaluate the validity of bowel preparation scientifically and standardly.