肠内营养用于术前肠道准备对结直肠癌患者腹腔和肠腔脱落癌细胞及复发转移的影响  

Effect of enteral nutrition as replacement of traditional bowel preparation on the intraperitoneal and intraluminal disseminated tumor cells, recurrence and metastasis in patients with colorectal cancer

作　　者：刘彦[1] 陶凯雄[1] 王国斌[1] 卢昕[2] 李晓辉[2] 黄洋[2] 叶芳[2] 

机构地区：[1]华中科技大学同济医学院附属协和医院胃肠外科,武汉430022 [2]武汉市第一医院胃肠外科

出　　处：《中华胃肠外科杂志》2013年第4期350-353,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：湖北省卫生厅基金（2009.232-JX4856）

摘　　要：目的探讨术前肠内营养代替肠道准备对结直肠癌患者腹腔和肠腔脱落癌细胞及转移复发的影响。方法2007年3月至2011年12月问前瞻性人组120例结直肠癌者，按随机数字表法随机分为试验组和对照组，每组60例。试验组于术前3d起每日口服30ml／kg肠内营养液，不进行灌肠，不口服泻药和抗生素；对照组采用传统肠道准备，包括术前禁食、口服抗生素和清洁灌肠。两组患者均于开腹后用400ml生理盐水冲洗肿瘤所在局部腹腔，抽取腹腔冲洗液200ml，迅速送检；并于肿瘤切除后肠吻合前，用1000ml生理盐水灌洗远端结直肠腔，收集肠腔冲洗液500ml，迅速送检。比较两组患者腹腔和肠腔内脱落的癌细胞阳性率及术后并发症发生率和复发转移率。结果试验组患者腹腔和肠腔内脱落癌细胞阳性率分别为8．3％（5／60）和15．0％（9／60）．明显低于对照组患者的12．5％（13／60）和31．7％（19／60）（P=0．041和P=O．031）。试验组和对照组分别有55例和57例患者完成随访，随访时间16—46个月；两组局部复发率[5．5％（3／55）比7．0％（4／57），P=O．733]、远处转移率[10．9％（6／55）比10．5％（6／57），P=O．984]和3年总体生存率（80％比78％，P=O．312）的差异均无统计学意义。结论术前肠内营养可减少结直肠癌患者腹腔和肠腔脱落癌细胞的阳性率，但并不影响术后局部复发率和远处转移率。Objective To study the effect of enteral nutrition as replacement of mechanical bowel preparation on peritoneal and intraluminal disseminated tumor cells, recurrence and metastasis in patients with colorectal cancer. Methods A total of 120 coloreetal cancer patients between March 2007 and December 2011 were enrolled prospectively and randomly divided into two groups. Group A（n=60） received preoperative bowel preparation with enteral nutrition fluid（ 30 ml＇kg-l-d-l）, without enema, taxative or antibiotics. Group B （n=60） underwent traditional intestinal preparation consecutively 3 clays before operation, including fasting, oral antibiotic, and cleaning enema. All the patients received peritoneal lavage with 400 ml of normal saline at the time of laparotomy and 200 ml of the lavage fluid was collected. All the cases underwent distal colorectal lavage with 1000 ml of normal saline before anastomosis, and 500 ml of the lavage fluid was collected. Fluid samples were quickly sent for exfoliated cytological examination. The positive rates of exfoliated cancer cell in peritoneal cavity and intraluminal cavity, postoperative complication, recurrence and metastasis were compared between the two groups. Results In group A, exfoliated cancer cells were found in 5 of 60 cases （8.3%） in peritoneal lavage fluid and in 9 of 60 cases（15.0%） in distal colorectal lavage fluid, while in group B, cancer cells were found in 13 of 60 cases（12.5%） and 19 of 60 cases（31.7%） respectively. There were significant differences between group A and B（P=0.041, P=0.031）. Fifty-five patients in group A were followed up froml6 to 46 months after surgery, as well 57 patients in group B. Rates of lacal recurrence and distant metastasis in Group A and B were 5.5% vs. 7.0% and 10.9% vs. 10.5% respectively. There were no significant differences（P=0.733, P=0.984）. There was no significant difference in 3-year survival rate between the two groups（80% vs. 78%, P=0.312）. Conclusions Enteral nutrition instead of trad

关 键 词：结直肠肿瘤 肠道准备 肠内营养 脱落癌细胞 肿瘤复发 肿瘤转移 

分 类 号：R735[医药卫生—肿瘤]