择期结直肠手术术前机械性肠道准备与抗生素肠道准备的研究进展

Research progress of preoperative mechanical bowel preparation and antibiotic bowel preparation for elective colorectal surgery

目前,结直肠癌的诊治理念已从原先的“经验医学”转入“循证医学”,针对结直肠手术术前肠道准备,国内外尚缺乏相应指南与规范指导临床应用。而随着快速康复外科理念的不断发展,术前机械性肠道准备(mechanical bowel preparation,MBP)不但会增加患者不适与精神经济负担,同时也会提高术前护理难度。本文综述了目前国内外现有文献证据表明,针对择期开腹或腹腔镜结肠手术,建议术前弃置MBP,采用单纯口服抗生素(oral antibiotic bowel preparation,OABP)的方法进行术前肠道准备。针对择期开腹直肠手术,术前MBP仍是必不可少的术前准备环节,针对择期腹腔镜直肠手术,建议OABP联合MBP作为常规术前肠道准备方法。然而,国人饮食习惯和结构与西方不同,更偏重于高纤维、低脂饮食,因此肠道中食物残渣含量高。且国内各机构腹腔镜诊治经验仍参差不齐。因此,亟待各机构或专业学术组织开展根据不同肿瘤位置、年龄、手术方式等针对国人的大规模、多中心、随机对照研究,以期验证最适合国人的择期结直肠手术术前肠道准备模式。

At present,the concept of diagnosis and treatment of colorectal cancer has been transferred from the origi-nal"empirical medicine"to"evidence-based medicine".In terms of preoperative bowel preparation for colorectal surgery,there is still a lack of relevant guidelines and norms to guide clinical application.With the continuous devel-opment of the concept of rapid rehabilitation surgery,preoperative mechanical bowel preparation(MBP)will not only increase patient discomfort and mental and economic burden,but also increase the difficulty of preoperative care.In this paper,the existing domestic and foreign literature evidence shows that for elective open or laparoscopic colon sur-gery,it is recommended to discard the MBP before surgery,and use oral antibiotic bowel preparation(OABP)method for preoperative PBP.For elective laparoscopic rectal surgery,preoperative MBP is still an essential part of preopera-tive preparation.For elective laparoscopic rectal surgery,OABP combined with MBP is recommended as a routine pre-operative bowel preparation method.However,the dietary habits and structure of Chinese people are different from those of the West,and they are more inclined to the high-fiber and low-fat diet.Therefore,the content of food resi-dues in the intestinal tract is high.Moreover,the experience of laparoscopic diagnosis and treatment in various domes-tic institutions is still uneven.Therefore,it is urgent for institutions or professional academic organizations to conduct large-scale,multicenter,randomized controlled studies on Chinese people according to different tumor sites and ages and surgical methods,in order to verify the most suitable preoperative intestinal preparation mode for Chinese people.