术前机械性肠道准备对结肠癌患者早期康复疗效的影响：随机对照试验

目的：对比“进行”或“不进行”术前机械性肠道准备对结肠癌患者术后早期康复效果的影响，探讨我国结肠癌患者群术前不进行机械性肠道准备的可行性。方法选择某三级甲等医院胃肠外科中心2014年7月~2016年2月期间某医疗组收治的需行择期一期吻合性切除术的结肠癌患者随机分为试验组和对照组，试验组患者不进行机械性肠道准备，对照组患者术前12 h进行机械性肠道准备。术后12 h内完成基线资料指标收集，患者的血红蛋白、总蛋白、白蛋白、前白蛋白及白球比等指标以术前1 d、术后第1和5天的数据为准，随访出院后至术后第30天患者并进行统计分析。结果最终纳入试验组76人，对照组72人。两组伤口感染，腹腔感染发生率的差异有统计学意义（P<0.05）。吻合口瘘及术后早期肠梗阻的发生率差异无统计学意义（P>0.05）。两组患者术后首次排气时间差异有统计学意义（P=0.03）。两组患者术后第1天的前白蛋白差异有统计学意义（P=0.03），手术时间比较差异无统计学意义（P=0.06）。结论结肠癌术前进行机械性肠道准备增加术后早期并发症发生率，延迟肠道运动功能恢复，影响术后早期营养状态。

Early outcomes of elective surgery for colon cancer with preoperative mechanical bowel preparation:a randomized clinical trial

Objective To compared the early outcomes of patients undergoing elective surgeries for colon cancer with and without preoperative mechanical bowel preparation. Methods Between July, 2014 and February, 2016, patients undergoing elective surgery for colon cancer with primary anastomosis were randomly assigned into control group with mechanical bowel preparation 12 h before surgery and treatment group without mechanical bowel preparation. Baseline data collection was completed within 12 h after the operation. The levels of hemoglobin, total protein, albumin, prealbumin and albumin/globulin ratio of the patients were recorded at 1 day before surgery and 1 day and 5 days after the surgery. The patients were followed up till 30 days after the surgeries and the complications were recorded. Results Seventy-six patients were assigned in the treatment group and 72 in the control group. Significant differences were found in the incidence of wound infection and intra-abdominal infection (P<0.05) but not in that of anastomotic leakage or early postoperative bowel obstruction (P>0.05) between the two 2 groups. The first flatus time (P=0.03) and prealbumin level on the first postoperative day (P=0.03) differed significantly between the two groups, but the operation time was similar between them (P=0.06). Conclusion In patients undergoing elective surgeries for colon cancer, preoperative mechanical bowel preparation is associated with increased postoperative complications, delayed recovery of intestinal motility and poorer nutrition status early after the operation.