结直肠癌术前不同肠道准备措施对根治术后近远期预后影响分析

Analysis of short- and long-term outcomes in colorectal cancer patients with different bowel preparations after radical surgery:a single-center randomized controlled trial

目的比较结直肠癌(CRC)术前肠内营养(EN)、快速肠道准备(RBP)以及传统肠道准备(TBP)对患者近期及远期预后的影响。方法选择2011年3月至2013年2月行根治性切除术的CRC患者183例,随机分为EN组、RBP组及TBP组,系统评估三组患者近、远期预后的差异。结果 EN、RBP、TBP组患者耐受情况良好者比例分别为95.1%、83.6%及52.5%(P<0.01);术前BP不良事件(腹痛/腹胀和恶心/呕吐)发生率分别为6.6%、14.8%及23.6%(P<0.01);EN组肠壁水肿比例最低,TBP组最高,三组肠壁水肿情况差异有统计学意义(P<0.01);术后腹泻比例分别为6.6%、11.5%和24.6%(P=0.013);EN组麻醉前、术后第1、3、5天出现生化异常比例最低,而TBP组比例最高;术后并发症发生率分别为9.8%、11.5%和14.8%(P=0.679);腹腔/肠腔脱落肿瘤细胞阳性者比例分别为3.3%、13.1%和18.0%(P=0.039);术后3年治疗失败比例分别为13.1%、18.0%和14.8%(P=0.744);术后肠道功能恢复时间、住院中位时间均差异有统计学意义(P=0.043、0.037)。结论 EN、RBP、TBP方案在CRC术前肠道准备中均安全有效。EN方案在患者耐受度、肠道清洁度、术后并发症方面可与RBP及TBP方案媲美,肠道水肿发生率、术后生化异常发生率更低。尽管EN方案能够有效降低腹腔/肠腔肿瘤细胞脱落发生率,但未能改善结直肠癌术后远期预后。

Objective To compare preoperative enteral nutrition(EN), rapid bowel preparation(RBP)and traditional bowel preparation(TBP)on postoperative short- and long- term outcomes in colorectal cancer(CRC)patients. Methods One hundred and eighty-three CRC patients underwent radical excision from March 2011 to February 2013. They were randomly divided into EN group, RBP group and TBP group, and outcomes in the three groups were assessed. Results Patients’ tolerance in EN group was better than the other two groups(95.1%, 83.6% and 52.5%, P<0.01). The adverse events rate of the three groups, including abdominal pain/abdominal distension and nausea/vomiting, was 6.6%,14.8% and 23.6%, respectively(P<0.01). The rate of edema of bowel wall in EN group was lower than that in RBP group, which was lower than in TBP group(P<0.01). The diarrhea rate of three groups was6.6%, 11.5% and 24.6%, respectively(P=0.013). The risk of biochemical disorders of preoperative anesthesia, 1, 3 and 5 days after surgery in EN group was lower than other two groups, and TBP group had the greatest risk of biochemical disorders. Postoperative complications, including wound infection, abdominal infection and anastomotic leakage, were 9.8%, 11.5% and 14.8%, respectively(P=0.679). The frequency of tumor cells in peritoneal/intestinal cavity tumor cells of the three groups were 3.3%, 13.1% and 18.0%(P=0.039). The 3- year local recurrence(LR)and/or distant metastasis(DM)in three groups were13.1%, 18.0% and 14.8%, respectively(P=0.744). Intestinal function recovery time and hospital stay differences among groups were statistically different(P=0.043, 0.037, respectively). Conclusions EN,RBP and TBP regimens are safe and effective in preoperative bowel preparation for colorectal cancer. In patients with EN, the degree of tolerance, intestinal clearance, postoperative complications were comparable to RBP and TBP. Edema of bowel wall in EN regimen was lower. Although the EN regimen can effectively reduce the incidence of peritoneal/intestinal cavity tumor cells, it can not improve the long-term prognosis of colorectal cancer.