结直肠癌术前机械性肠道准备的可行性分析

doi:10.3877/cma.j.issn.1674-0793.2018.05.012

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。

关键词: 结直肠肿瘤, 机械性肠道准备, 应激反应

Objective

To investigate the feasibility of non preoperative mechanical bowel preparation (MBP) for the colorectal cancer resection.

Methods

A 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.

Results

There 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).

Conclusions

Preoperative 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.

Key words: Colorectal neoplasms, Mechanical bowel preparation, Stress response

表1 两组结直肠癌患者一般资料比较

组别	例数	性别(男/女,例)	年龄(岁, ±s)	TNM分期(例)			ASA评分(例)			术前CEA(μg/L，例)		术前CA19-9(kU/L，例)
组别	例数	性别(男/女,例)	年龄(岁, ±s)	Ⅱ	Ⅲ	Ⅳ	Ⅰ	Ⅱ	Ⅲ	≤5	>5	≤37	>37
non-MBP组	53	31/22	56.29±10.47	22	26	5	2	32	19	45	8	48	5
MBP组	51	28/23	54.67±11.28	20	28	3	3	26	22	42	9	47	4
统计值	?	0.213	0.616^a	0.618			0.731			2.174		2.629
P值	?	0.507	0.473	0.607			0.854			0.926		0.905
组别	合并疾病(例)					肿瘤部位(例)				吻合方式(例)
组别	糖尿病	冠心病	慢性阻塞性肺病	高血压	肝病	升结肠	横结肠	降结肠	直肠	回-结肠	结肠-结肠	结肠-直肠	Miles术
non-MBP组	6	1	2	7	2	10	5	11	27	10	16	25	2
MBP组	4	2	3	9	1	12	3	12	24	12	15	22	2
χ²值	0.426					0.461				0.648
P值	0.619					0.714				0.928

表1 两组结直肠癌患者一般资料比较

组别	例数	性别(男/女,例)	年龄(岁, ±s)	TNM分期(例)			ASA评分(例)			术前CEA(μg/L，例)		术前CA19-9(kU/L，例)
组别	例数	性别(男/女,例)	年龄(岁, ±s)	Ⅱ	Ⅲ	Ⅳ	Ⅰ	Ⅱ	Ⅲ	≤5	>5	≤37	>37
non-MBP组	53	31/22	56.29±10.47	22	26	5	2	32	19	45	8	48	5
MBP组	51	28/23	54.67±11.28	20	28	3	3	26	22	42	9	47	4
统计值	?	0.213	0.616^a	0.618			0.731			2.174		2.629
P值	?	0.507	0.473	0.607			0.854			0.926		0.905
组别	合并疾病(例)					肿瘤部位(例)				吻合方式(例)
组别	糖尿病	冠心病	慢性阻塞性肺病	高血压	肝病	升结肠	横结肠	降结肠	直肠	回-结肠	结肠-结肠	结肠-直肠	Miles术
non-MBP组	6	1	2	7	2	10	5	11	27	10	16	25	2
MBP组	4	2	3	9	1	12	3	12	24	12	15	22	2
χ²值	0.426					0.461				0.648
P值	0.619					0.714				0.928

表2 两组结直肠癌患者手术前后机体应激反应指标水平比较（±s）

组别	例数	IL-6(ng/L)			Cor(μg/L)			hs-CRP(mg/L)
组别	例数	术前4 d	术后24 h	术后48 h	术前4 d	术后24 h	术后48 h	术前4 d	术后24 h	术后48 h
non-MBP组	53	3.74±1.25	5.28±1.72	5.36±1.32	171.4±30.8	247.8±34.3	238.3±30.7	0.74±0.37	5.79±0.68	5.27±0.53
MBP组	51	3.52±1.46	8.94±2.18	7.61±1.47	173.1±31.6	368.1±37.9	342.5±32.6	0.79±0.25	9.43±1.45	8.64±1.86
t值	?	0.637	2.374	2.638	1.482	2.547	2.645	-0.705	3.486	3.419
P值	?	0.508	0.013	0.004	0.169	0.016	0.008	0.416	0.001	0.002

表2 两组结直肠癌患者手术前后机体应激反应指标水平比较（±s）

组别	例数	IL-6(ng/L)			Cor(μg/L)			hs-CRP(mg/L)
组别	例数	术前4 d	术后24 h	术后48 h	术前4 d	术后24 h	术后48 h	术前4 d	术后24 h	术后48 h
non-MBP组	53	3.74±1.25	5.28±1.72	5.36±1.32	171.4±30.8	247.8±34.3	238.3±30.7	0.74±0.37	5.79±0.68	5.27±0.53
MBP组	51	3.52±1.46	8.94±2.18	7.61±1.47	173.1±31.6	368.1±37.9	342.5±32.6	0.79±0.25	9.43±1.45	8.64±1.86
t值	?	0.637	2.374	2.638	1.482	2.547	2.645	-0.705	3.486	3.419
P值	?	0.508	0.013	0.004	0.169	0.016	0.008	0.416	0.001	0.002

表3 两组结直肠癌患者术后并发症情况比较［例(%)］

组别	例数	吻合口漏	切口感染	术野冲洗液细菌阳性	球杆菌比例失调	腹泻	术后早期肠梗阻
non-MBP组	53	1(1.8)	2(3.7)	5(9.4)	4(7.5)	3(5.6)	1(1.8)
MBP组	51	0(0)	3(5.8)	7(13.7)	12(23.5)	8(15.6)	0(0)
χ²值	?	-	0.184	0.215	4.367	8.341	-
P值	?	0.153	0.209	0.418	0.037	0.009	0.153^a

表3 两组结直肠癌患者术后并发症情况比较［例(%)］

组别	例数	吻合口漏	切口感染	术野冲洗液细菌阳性	球杆菌比例失调	腹泻	术后早期肠梗阻
non-MBP组	53	1(1.8)	2(3.7)	5(9.4)	4(7.5)	3(5.6)	1(1.8)
MBP组	51	0(0)	3(5.8)	7(13.7)	12(23.5)	8(15.6)	0(0)
χ²值	?	-	0.184	0.215	4.367	8.341	-
P值	?	0.153	0.209	0.418	0.037	0.009	0.153^a

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Feasibility analysis of colorectal cancer with preoperative mechanical bowel preparation

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Feasibility analysis of colorectal cancer with preoperative mechanical bowel preparation