复方聚乙二醇电解质散行结直肠癌肠道准备时C-反应蛋白的变化

目的 观察复方聚乙二醇电解质散用于结直肠癌术前肠道准备对肠道免疫屏障组织损伤的影响.方法 将60例结直肠癌手术患者随机分为观察组和对照组各30例,观察组术前口服复方聚乙二醇电解质散、对照组口服甘露醇行肠道准备.分别观察患者对G反应蛋白(CRP)含量的变化.结果 观察组患者CRP含量显著低于对照组(P＜0.05).结论 复方聚乙二醇电解质散作为结直肠癌术前肠道准备能减轻肠道免疫屏障组织损伤,是较为安全的一种肠道准备方法.     

Prophylaxis with whole gut irrigation and antimicrobials in colorectal surgery. A prospective, randomized double-blind clinical trial

In a prospective, randomized double-blind trial, the efficacy of whole gut irrigation as preoperative bowel preparation for elective colorectal surgery was evaluated alone and in combination with two antimicrobial agents in 148 patients. The antimicrobial regimens were metronidazole alone or metronidazole and ampicillin administered systemically preoperatively and continued for 3 days. Whole gut irrigation was completed without any discomfort in 87 percent of the patients. In 3 percent, the irrigation was stopped and the patients were excluded from the study. Abdominal wound infection developed in 32 percent of the patients after whole gut irrigation, and the addition of metronidazole decreased this incidence to 22 percent (not significant). The incidence in wound infections in the group receiving metronidazole as well as ampicillin was 2 percent, and this difference was highly significant compared with both other groups. No significant difference was found for the incidence of intraabdominal abscesses (p = 0.06), infection of the perineal wound, or anastomotic leakage. No difference in the postoperative infection rate was found between a bowel containing fecal fluid or fecal masses, but when a bowel was clean, significantly fewer infectious complications were found. Whole gut irrigation is a rapid, well-tolerated, easily performed, and safe form of preoperative bowel preparation in elective colorectal surgery if combined with systemic antimicrobial prophylaxis consisting of antimicrobial agents effective against anaerobic and aerobic organisms.     

Preoperative polyethylene glycol versus a single enema in elective bowel surgery

BACKGROUND: At the beginning of 2004, a large Dutch randomized study comparing mechanical bowel preparation with a single preoperative enema reported no differences in anastomotic leakage rates, septic complications, or mortality. On the basis of this study, this institution abandoned the routine practice of bowel preparation with polyethylene glycol and introduced a single preoperative enema. METHODS: A consecutive series of 78 patients undergoing elective colorectal surgery with mechanical bowel preparation using polyethylene glycol (PG group) was compared to a consecutive series of 71 patients with a single preoperative enema (SE group). The PG group was operated between June 2003 and December 2004, the SE group between January 2005 and January 2006. Mortality, anastomotic leakage, and infectious and noninfectious complications were compared. RESULTS: Mortality, anastomotic leakage, frequency of reoperations, and hospital stay were comparable for both groups. The overall postoperative morbidity was significantly higher in the SE group (26 vs. 9, p = 0.003). Specifically, the incidence of wound infections was significantly higher in the SE group (7 vs. 1, p = 0.041). Furthermore, a trend was observed in the incidence of intra-abdominal infections which was higher in the SE group (8 vs. 2, p = 0.070). Also a trend toward more extra-abdominal infectious complications was seen in the SE group (11 vs. 4, p = 0.086). CONCLUSIONS: Based on both the conflicting data currently available from different randomized studies and our results, the preoperative bowel preparation protocol in our institution has been changed. All left-sided colonic resections, in patients who can tolerate mechanical bowel preparation, are prepared with polyethylene glycol.     

The safety and cost-effectiveness of polyethylene glycol electrolyte solution bowel preparation in infants and children

Golytely, a polyethylene glycol electrolyte solution (Braintree Laboratories, Braintree, MA), was evaluated in the preoperative bowel preparation of 21 infants and children. Weight, temperature, pulse, respiratory rate, and electrolyte concentrations were documented before and after mechanical bowel preparation. All children were given 25 mL/kg/h of Golytely until rectal effluent was clear and free of particulate matter. All preparations were started and completed the afternoon prior to surgery. Weight, vital signs, and electrolyte concentrations did not change significantly. All preparations were felt to be fair or excellent. Follow-up for 1 month postoperatively revealed no infectious complications. Golytely is safe and effective in preparing the bowel prior to surgery in children. Using Golytely can eliminate the need for multiple-day hospitalizations for bowel preparation and thus decrease the cost of medical care.     

Polyethylene glycol electrolyte lavage solution (PEG-ELS). A rapid, safe mechanical bowel preparation for colorectal surgery

The use of polyethylene glycol electrolyte lavage solution (PEG-ELS) as a whole-bowel irrigation for colorectal surgery is retrospectively evaluated in 65 consecutive patients. Sixty-three (97%) of the patients were able to complete the lavage. Fifty-five (85%) of these tolerated the preparation without event. Unpleasant reactions of nausea, vomiting, or fullness resolved in most patients by decreasing the rate of ingestion. Twenty-seven patients had associated medical illnesses that may have been aggravated by volume overload, but none of these experienced any adverse effects from the lavage. Most patients completed the total lavage ingestion of 4 L in 4 hours, which resulted in a 1-day preparation prior to operation. There were no wound or septic complications in any of the lavage patients. This clinical review indicates that PEG-ELS is a safe, rapid, and effective mechanical bowel preparation that should be able to reduce in-hospital preparation time for most patients undergoing colorectal surgery.     

Polyethylene glycol versus sodium phosphate mechanical bowel preparation in elective colorectal surgery

BACKGROUND: The type of mechanical bowel preparation (MBP) used before elective colorectal surgery remains controversial. METHODS: This post hoc analysis of a prospective randomized controlled antibiotic prophylaxis trial (ertapenem vs. cefotetan) evaluated the effect of polyethylene glycol (PEG) and sodium phosphate (SP) MBPs on the rates of postoperative surgical site infections (SSI). RESULTS: Good to excellent MBPs were observed in 281 of 303 (93%) evaluable patients for the PEG and 336 of 367 (92%) for the SP types. A higher rate of SSI was observed in the PEG (34%) than SP (24%) group (difference, 10%; 95% confidence interval, 3.4-17.2). The MBP type was a significant risk factor for SSI, with SP favored over PEG (odds ratio, .6; 95% confidence interval, .43-.85) in univariate analysis; multivariate analysis favored SP, but was not significant (odds ratio, .69; 95% confidence interval, .46-1.02). SSI was lowest with SP and ertapenem (19%) and highest with PEG and cefotetan (44%). CONCLUSIONS: SP, coupled with ertapenem antibiotic prophylaxis, may improve outcomes and reduce SSIs in patients undergoing elective colorectal surgery when compared with PEG coupled with cefotetan antibiotic prophylaxis.     

Emergency surgery for colorectal cancer does not result in nodal understaging compared with elective surgery

Background

It has been suggested that inadequate lymph node harvest may result in pathologically understaged or indeterminate staging of patients with colorectal cancer (CRC). We compared the adequacy of nodal staging in patients undergoing emergency surgery compared with elective surgery for CRC.

Methods

Using a prospectively collected CRC surgery database at a tertiary care centre, we performed a cohort study. The mean number of lymph nodes harvested and the proportion of patients who had inadequate staging (< 12 nodes harvested) were compared between emergency and elective surgery cohorts. Our analysis was adjusted for tumour site, type of resection, surgical training and pathologic stage.

Results

A total of 1279 of 1356 (94%) enrolled patients had nodal data available for analysis; 161 (13%) patients had emergency surgery and 1118 (87%) had elective surgery. The mean number of nodes removed was higher in the emergency surgery group (mean difference +2.8, 95% confidence interval [CI] 0.6–5.1, p = 0.012). The proportion of patients with inadequate nodal staging did not differ between groups (emergent 16%, elective 17%, p = 0.79). The odds of adequate nodal staging, adjusting for site, type of resection, training and stage was no different between groups (OR 0.80, 95% CI 0.47–1.35, p = 0.41).

Conclusion

The evidence does not support the common belief that emergency surgery is more commonly understaged in CRC. Our data suggest emergency surgery resulted in a significant increase in the average number of nodes harvested, with no difference in inadequate nodal staging.     

Preparation of the bowel before elective surgery using a polyethylene glycol solution at home and in hospital compared with conventional preparation using magnesium sulphate

Bowel preparation by conventional methods is time-consuming and unpleasant for both patient and staff. In addition, it requires admission to hospital several days before surgery. Preparation using oral polyethylene glycol solution is more acceptable and can easily be adapted so that the patient can perform the procedure at home before admission to hospital. In a prospective series we have compared the efficacy of preparation at home using polyethylene glycol with similar preparation in hospital and with a standard bowel preparation based on magnesium sulphate. Preparation was better after polyethylene glycol and this was significant when performed at home (P less than 0.01). There was no effect on either electrolytes or haematological parameters, but polyethylene glycol did result in a rise in the number of colonic Streptococcus faecalis seen. This rise was not seen with magnesium sulphate (P less than 0.001).     

A physiological appraisal of polyethylene glycol and a balanced electrolyte solution as bowel preparation

Seventy-seven patients undergoing bowel preparation with either sennosides and rectal washout (S + RWO; n = 26) or polyethylene glycol and a balanced electrolyte solution (PEG + E) given orally (n = 25) or by nasogastric infusion (n = 26) have been studied. PEG + E was not associated with significant physiological change in electrolytes or blood gases. Patients tolerated PEG + E well and it provided a moderate to good bowel preparation in over 80 per cent of cases. PEG + E was not associated with a change in colonic microflora and was not associated with explosive mixtures of colonic gas due to hydrogen. It is therefore a safe, quick and efficient bowel preparation and provides a safer alternative to mannitol. The solution (PEG + E) man be used orally or by nasogastric infusion and does not require an accompanying intravenous infusion.     

The role of Picolax before whole gut irrigation in the preparation of the colon for large bowel surgery.

Whole gut irrigation is easier for the patient and more likely to be successful if the colon is prepared before irrigation. This study compared Picolax, given the day before irrigation, with an enema regimen and showed that there was no difference in the volume of fluid required and the time taken for whole gut irrigation to produce a clear effluent between the two groups.     

The efficacy of polyethylene glycol-electrolyte lavage solution versus traditional mechanical bowel preparation for elective colonic surgery: a randomized, prospective, blinded clinical trial

This study documents the efficacy, safety and patient tolerance of GoLYTELY (Braintree Laboratories, Inc., Braintree, Mass.) an orally administered, nonexplosive, polyethylene glycol-electrolyte lavage solution, in elective colonic surgery. Fifty-three patients admitted for colonic surgery were randomized to either GoLYTELY or a traditional 3-day bowel preparation. Both groups received oral and perioperative antibiotics. Pre- and postpreparation weights, blood chemistries, and hematologic values were obtained. Postpreparation patient tolerance was assessed. During surgery the surgeon scored the bowel for the presence of retained air, fluid, or feces. Standardized semiquantitative aerobic and anaerobic bacterial counts were obtained from sigmoid aspirates. Postoperative infectious complications were recorded. Mechanical preparation with GoLYTELY resulted in a greater feeling of fullness, while the traditional preparation produced more hunger and abdominal cramping. The use of GoLYTELY resulted in better scores of overall quality and bowel appearance, reflecting a greater efficiency with which it removed air, fluid, and feces from the bowel. GoLYTELY also resulted in significantly fewer total aerobic and anaerobic organisms in sigmoid aspirates. This study suggests that GoLYTELY is a safe, well-tolerated, and effective orthograde lavage solution that has significant advantages over other mechanical preparations and should be considered the preparation of choice for elective colonic surgery.     

腹腔镜结直肠癌根治与传统根治手术疗效的临床效果对比分析

目的对比腹腔镜结直肠癌根治与传统根治手术疗效的临床效果,为今后结直肠癌患者的手术治疗提供依据。方法选取2010年1月至2014年12月126例结直肠癌患者进行试验观察,分为腹腔镜组与开腹组,每组63例。采用SPSS16.0统计学软件进行统计学分析,术中出血量、手术时间、切除肠管长度、术后愈合情况等计量资料用(x珋±s)表示,采用t检验;并发症发生率、复发率和转移率采用χ~2检验,P0.05时为差异有统计学意义。结果腹腔镜组与开腹组患者的术中出血量为(54.6±20.3)ml和(162.8±80.6)ml;开腹组的手术时间为(172.8±30.2)min,腹腔镜组的手术时间为(252.2±60.4)min,腹腔镜组与开腹组间的差异具有统计学意义(t=5.523,t=6.385,P0.05)。腹腔镜组与开腹组的肛门排气时间为(2.1±0.3)d和(3.6±0.3)d;腹腔镜组与开腹组的住院时间为(10.9±2.5)d和(19.1±11.9)d,腹腔镜组与开腹组的差异具有统计学意义(t=5.862、6.754,P0.05);且腹腔镜组与开腹组患者的并发症发生率、复发率和转移率等差异无统计学意义(P0.05)。结论腹腔镜结直肠癌具有较高的临床疗效,并能够对患者的损伤较小,住院时间短,显著改善患者的预后,能够在临床治疗结直肠癌中推广使用。     

The "Mannit-Ceftriaxon" preparation for elective colorectal surgery.

Authors report their experiences with evaluating the clinical course of 45 patients undergoing elective colorectal surgery. Patients were divided into three groups, depending on the type and method of preparation to operation. The 140 patients in the first group received according to the "traditional" preparation purgatives, enemas, and mycerine + metronidazole prophylaxis. The preparation of the 160 patients involved in the second group was performed by giving mannit solution (10%) orally 12 hours prior to surgery, and a single dose of 2 g ceftriaxon (Rocephin, Hoffman-La Roche) intravenously 2 hours preoperatively. The preparation for the 150 patients enrolled into the third group was done also by giving mannit solution orally, and for antibiotic prophylaxis 2 g ceftriaxon was given intravenously as in the second group, but an additional 500 mg metronidazole was also given at the same time as the ceftriaxon intravenously. The evaluation of the cases proves, that the mannit + ceftriaxon method warrants satisfactory protection for colorectal surgery, and the necessary time interval is only 12 hours. The rate of septic complications and septic death was higher in the first, traditionally pretreated group, than in the other two. The CTX + metronidazole combination used in the third group was not superior to the administration of ceftriaxon alone.