Feasibility analysis of colorectal cancer with preoperative mechanical bowel preparation

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

Abstract

Abstract:

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

Xiaoliang Yang, Jing Yan, Yanjun Wu, Xiaolin Yue, Tihong Qiu, Peigen Liu, Yinghong Yang. Feasibility analysis of colorectal cancer with preoperative mechanical bowel preparation[J]. Chinese Archives of General Surgery(Electronic Edition), 2018, 12(05): 337-341.

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References 16

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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

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

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

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

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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