结直肠癌术前机械性肠道准备的可行性分析

目的探讨结直肠癌患者术前不实施机械性肠道准备（MBP）的可行性。 方法前瞻性选择2016年9月至2018年1月攀枝花市中心医院收治的结直肠癌患者104例，采用随机数字表法分为非机械性肠道准备组（non-MBP组）53例和机械性肠道准备组（MBP组）51例。观察两组术后并发症的发生和机体应激反应指标的变化。 结果两组术前的hs-CRP、IL-6、Cor水平差异无统计学意义；non-MBP组术后24、48 h时的IL-6、Cor及hs-CRP水平均显著低于同期MBP组，差异有统计学意义（均P<0.05）。监测术后30 d并发症，两组患者均未发生腹腔感染，吻合口漏、切口感染、术野冲洗液细菌培养、术后肠梗阻的发生率比较，差异无统计学意义。non-MBP组患者球杆菌比例失调、腹泻的发生率分别为7.5%（4/53）、5.6%（3/53），显著低于MBP组的23.5%（12/51）、15.6%（8/51），差异有统计学意义（χ²=4.367、8.341，P=0.037、0.009）。 结论术前MBP会加重结直肠癌患者术后机体的应激反应，结直肠癌择期手术术前可不行MBP，并不增加术后并发症的发生。

Feasibility analysis of colorectal cancer with preoperative mechanical bowel preparation

ObjectiveTo investigate the feasibility of non preoperative mechanical bowel preparation (MBP) for the colorectal cancer resection. MethodsA prospective study was conducted on one hundred and four patients with colorectal cancer who were admitted to the Central Hospital of Panzhihua City from September 2016 to January 2018. They were divided into non-MBP group (53 cases) and MBP group (51 cases) using random number table method. The incidence of postoperative complications and the changes of stress response in both groups were observed. ResultsThere were no significant differences in the levels of hs-CRP, IL-6 and Cor before operation between the two groups. The levels of IL-6, Cor and hs-CRP at postoperative 24 and 48 h in the non-MBP group were significantly lower than those of the MBP group in the same period, and the difference was statistically significant (all P<0.05). No intra-abdominal infection occurred in both groups. No significant differences were found in the postoperative complications of 30 d including wound infection rate, anastomotic leakage rate, early postoperative bowel obstruction rate and bacterial culture of surgical area rinse solution. The incidence of bacillus/coccus ratio imbalance and diarrhea in non-MBP group were 7.5% (4/53) and 5.6% (3/53) respectively, which were significantly lower than 23.5% (12/51) and 15.6% (8/51) in MBP group, the differences were statistically significant (χ²=4.367, 8.341; P=0.037, 0.009). ConclusionsPreoperative MBP can aggravate postoperative stress response in patients with colorectal cancer, which is not necessary for elective surgery. Non-MBP does not increase the incidence of postoperative complications.