大腸擇期手術前行機械腸道準備的必要性探討_《中國循證醫學雜志》

作者：

賴瑋婧 ¹ , 汪曉東 ² ,  李立 ²

1. 四川大學華西臨床醫學院/華西醫院（成都 610041）；2. 四川大學華西醫院肛腸外科;

關鍵詞：

機械腸道準備大腸擇期手術術前準備證據

DOI：

10.7507/1672-2531.20090180

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　通過檢索和評價現有醫學證據，指導大腸擇期手術前腸道準備方案的選擇。
方法　針對具體問題提出相關臨床問題，檢索、篩選并評價對近10 年PubMed、MEDLINE、EMbase、Cochrane 圖書館、Science 和ACP 網站有關大腸擇期手術前準備的文獻。
結果　共納入17 篇文獻，其中系統評價2 篇，Meta 分析6 篇，隨機對照試驗9 篇。大多研究表明大腸擇期手術前機械腸道準備無益處，不做機械腸道準備并不增加吻合口漏的發生率。相反，機械腸道準備還可能導致吻合口漏發生率和傷口并發癥增加。據此，我們對該患者選擇了不做機械腸道準備的一種創新性簡化術前腸道準備方案，與我國臨床實際相結合并收到預期效果。
結論　幾乎有所系統評價和Meta 分析均表明無證據支持大腸擇期手術前機械腸道準備有益。而文中報道的華西醫院簡化術前腸道準備方案值得進一步研究。

引用本文： 賴瑋婧,汪曉東,李立. 大腸擇期手術前行機械腸道準備的必要性探討. 中國循證醫學雜志, 2009, 09(9): 1022-1025. doi: 10.7507/1672-2531.20090180 復制

1.	van Geldere D, Fa-Si-Oen P, Noach LA, et al. Complications after Colorectal Surgery Without Mechanical Bowel Preparation. J Am Coll Surg, 2002, 194(1): 40-47.
2.	Horgan AF, Stuart RC, O’Shaughnessy EM, et al. Bacterial translocation during peroperative colonic lavage of the obstructed rat colon [see comments]. Br J Surg, 1994, 81: 1796-1798.
3.	Kale TI, Kuzu MA, Tekeli A, et al. Aggressive bowel preparation does not enhance bacterial translocation, provided the mucosal barrier is not disrupted: a prospective, randomized study. Dis Colon Rectum, 1998, 41: 636-641.
4.	Keighley MR. A clinical and physiological evaluation of bowel preparation for elective colorectal surgery. World J Surg, 1982, 6: 464-470.
5.	Ambrose NS, Keighley MR. Physiological consequences of orthograde lavage bowel preparation for elective colorectal surgery: a review. J R Soc Med, 1983, 76(9): 767-771.
6.	Irving AD, Scrimgeour D. Mechanical bowel preparation for colonic resection and anastomosis. Br J Surg, 1987, 74(7): 580-581.
7.	梁偉雄, 張彤, 洪云, 等. 管飼全腸內營養在大腸癌術前應用的臨床研究. 中國實用外科雜志, 2005, 25(12): 737-738.
8.	Granberry MC, White LM, Gardner SF. Exacerbation of congestive heart failure failure after administration of polyethylene glycolelectrolyte lavage solution. Ann Phar, 1995, 29(12): 1232-1235.
9.	Fa-Si-Oen P, Roumen R, Buitenweg J, et al. Mechanical bowel preparation or not? Outcome of a multicenter, randomized trial in elective open colon surgery[Abstract]. Dis Colon Rectum, 2005, 48(8): 1509-1516.
10.	Ram E, Sherman Y, Weil R, et al. Is mechanical bowel preparation mandatory for elective colon surgery, a prospective randomized study? Arch Surg, 2005, 140: 285-288.
11.	Zmora O, Bar-Zakai B, Shabtai M, et al. Is mechanical bowel preparation mandatory for left-sided colonic anastomosis? Results of a prospective randomized trial. Tech Coloproctol, 2006, 10: 131-135.
12.	Zmora O, Mahajna A, Bar-Zakai B, et al. Colon and rectal surgery without mechanical bowel preparation: a randomized prospective trial. Ann Surg, 2003: 363-367.
13.	Contant CME, Hop WCJ, Pieter van’t Sant H, et al. Mechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial. Lancet, 2007, 370: 2112-2117.
14.	Jung B, Pahlman L, Nystro¨m PO, et al. Multicentre randomized clinical trial of mechanical bowel preparation in elective colonic resection. Br J Surgery, 2007, 94: 689-695.
15.	Bucher P, Gervaz P, Soravia C, et al. Randomized clinical trial of mechanical bowel preparation versus no preparation before elective left-sided colorectal surgery. Br J Surg, 2005, 92: 409-414.
16.	Miettinen RPJ, Laitinen ST, Makela JT, et al. Bowel preparation with oral polyethylene glycol electrolyte solution vs. no preparation in elective open colorectal surgery. Dis Colon Rectum, 2000, 43: 669-677.
17.	Wille-J?rgensen P, Guenaga KF, A. Castro A, et al. Clinical value of preoperative mechanical bowel cleansing in elective colorectal surgery: a systematic review. Dis Colon Rectum, 2003, 46: 1013-1020.
18.	Bucher P, Mermillod B, Gervaz P, et al. Mechanical Bowel Preparation for Elective Colorectal Surgery, A meta-analysis. Arch Surg, 2004, 139: 1359-1364.
19.	Guenaga K, Atallah AN, Castro AA, et al. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD001544. DOI: 10.1002/14651858.CD001544.pub2.
20.	Gravante G, Caruso R, Andreani SM, et al. Mechanical bowel preparation for colorectal surgery:a meta-analysis on abdominal and systemic complications on almost 5,000 patients. Int J Colorectal Dis, 2008, 23: 1145-1150.
21.	Pineda CE, Shelton AA, Hernandez-Boussard T, et al. Mechanical bowel preparation in intestinal surgery: a meta-analysis and review of the literature. J Gastrointest Surg, 2008, 12(11): 2037-2044.
22.	Bucher P, Gervaz P, Egger JF, et al. Morphologic alterations associated with mechanical bowel preparation before elective colorectal surgery: a randomized trial. Dis Colon Rectum, 2005, 49: 109-112.
23.	Slim K, Vicaut E, Panis Y, et al. Meta-analysis of randomized clinical trials of colorectal surgery with or without mechanical bowel preparation. Br J Surg, 2004, 91: 1125-1130.
24.	Bucher P, Mermillod B, Morel P, et al. Does mechanical bowel preparation have a role in preventing postoperative complications in elective colorectal surgery? A meta-analysis. Swiss Med Wkly, 2004, 134: 69-74.
25.	Wille-J?rgensen p, Guenaga KF, Matos D, et al. Pre-operative mechanical bowel cleansing or not? an updated meta-analysis. Colorectal Dis, 2005, 7(4): 304-310.

1. van Geldere D, Fa-Si-Oen P, Noach LA, et al. Complications after Colorectal Surgery Without Mechanical Bowel Preparation. J Am Coll Surg, 2002, 194(1): 40-47.
2. Horgan AF, Stuart RC, O’Shaughnessy EM, et al. Bacterial translocation during peroperative colonic lavage of the obstructed rat colon [see comments]. Br J Surg, 1994, 81: 1796-1798.
3. Kale TI, Kuzu MA, Tekeli A, et al. Aggressive bowel preparation does not enhance bacterial translocation, provided the mucosal barrier is not disrupted: a prospective, randomized study. Dis Colon Rectum, 1998, 41: 636-641.
4. Keighley MR. A clinical and physiological evaluation of bowel preparation for elective colorectal surgery. World J Surg, 1982, 6: 464-470.
5. Ambrose NS, Keighley MR. Physiological consequences of orthograde lavage bowel preparation for elective colorectal surgery: a review. J R Soc Med, 1983, 76(9): 767-771.
6. Irving AD, Scrimgeour D. Mechanical bowel preparation for colonic resection and anastomosis. Br J Surg, 1987, 74(7): 580-581.
7. 梁偉雄, 張彤, 洪云, 等. 管飼全腸內營養在大腸癌術前應用的臨床研究. 中國實用外科雜志, 2005, 25(12): 737-738.
8. Granberry MC, White LM, Gardner SF. Exacerbation of congestive heart failure failure after administration of polyethylene glycolelectrolyte lavage solution. Ann Phar, 1995, 29(12): 1232-1235.
9. Fa-Si-Oen P, Roumen R, Buitenweg J, et al. Mechanical bowel preparation or not? Outcome of a multicenter, randomized trial in elective open colon surgery[Abstract]. Dis Colon Rectum, 2005, 48(8): 1509-1516.
10. Ram E, Sherman Y, Weil R, et al. Is mechanical bowel preparation mandatory for elective colon surgery, a prospective randomized study? Arch Surg, 2005, 140: 285-288.
11. Zmora O, Bar-Zakai B, Shabtai M, et al. Is mechanical bowel preparation mandatory for left-sided colonic anastomosis? Results of a prospective randomized trial. Tech Coloproctol, 2006, 10: 131-135.
12. Zmora O, Mahajna A, Bar-Zakai B, et al. Colon and rectal surgery without mechanical bowel preparation: a randomized prospective trial. Ann Surg, 2003: 363-367.
13. Contant CME, Hop WCJ, Pieter van’t Sant H, et al. Mechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial. Lancet, 2007, 370: 2112-2117.
14. Jung B, Pahlman L, Nystro¨m PO, et al. Multicentre randomized clinical trial of mechanical bowel preparation in elective colonic resection. Br J Surgery, 2007, 94: 689-695.
15. Bucher P, Gervaz P, Soravia C, et al. Randomized clinical trial of mechanical bowel preparation versus no preparation before elective left-sided colorectal surgery. Br J Surg, 2005, 92: 409-414.
16. Miettinen RPJ, Laitinen ST, Makela JT, et al. Bowel preparation with oral polyethylene glycol electrolyte solution vs. no preparation in elective open colorectal surgery. Dis Colon Rectum, 2000, 43: 669-677.
17. Wille-J?rgensen P, Guenaga KF, A. Castro A, et al. Clinical value of preoperative mechanical bowel cleansing in elective colorectal surgery: a systematic review. Dis Colon Rectum, 2003, 46: 1013-1020.
18. Bucher P, Mermillod B, Gervaz P, et al. Mechanical Bowel Preparation for Elective Colorectal Surgery, A meta-analysis. Arch Surg, 2004, 139: 1359-1364.
19. Guenaga K, Atallah AN, Castro AA, et al. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD001544. DOI: 10.1002/14651858.CD001544.pub2.
20. Gravante G, Caruso R, Andreani SM, et al. Mechanical bowel preparation for colorectal surgery:a meta-analysis on abdominal and systemic complications on almost 5,000 patients. Int J Colorectal Dis, 2008, 23: 1145-1150.
21. Pineda CE, Shelton AA, Hernandez-Boussard T, et al. Mechanical bowel preparation in intestinal surgery: a meta-analysis and review of the literature. J Gastrointest Surg, 2008, 12(11): 2037-2044.
22. Bucher P, Gervaz P, Egger JF, et al. Morphologic alterations associated with mechanical bowel preparation before elective colorectal surgery: a randomized trial. Dis Colon Rectum, 2005, 49: 109-112.
23. Slim K, Vicaut E, Panis Y, et al. Meta-analysis of randomized clinical trials of colorectal surgery with or without mechanical bowel preparation. Br J Surg, 2004, 91: 1125-1130.
24. Bucher P, Mermillod B, Morel P, et al. Does mechanical bowel preparation have a role in preventing postoperative complications in elective colorectal surgery? A meta-analysis. Swiss Med Wkly, 2004, 134: 69-74.
25. Wille-J?rgensen p, Guenaga KF, Matos D, et al. Pre-operative mechanical bowel cleansing or not? an updated meta-analysis. Colorectal Dis, 2005, 7(4): 304-310.

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大腸擇期手術前行機械腸道準備的必要性探討

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《中國循證醫學雜志》

大腸擇期手術前行機械腸道準備的必要性探討

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