口服抗生素用于结直肠癌术前肠道准备的前瞻性研究  

A prospective study on the use of oral antibiotics for bowel preparation before colorectal cancer surgery

作　　者：王孟文 张驰 胡桂[1] 林昌伟[1] 叶永鑫 张翼[1] WANG Mengwen;ZHANG Chi;HU Gui;LIN Changwei;YE Yongxin;ZHANG Yi(Department of Gastrointestinal Surgery,the Third Xiangya Hospital,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院胃肠外科,湖南长沙410013

出　　处：《中国普通外科杂志》2024年第8期1274-1286,共13页China Journal of General Surgery

基　　金：湖南省自然科学基金资助项目(2023JJ30857)。

摘　　要：背景与目的:择期结直肠手术术前常规开展机械性肠道准备(MBP)和预防性静脉注射抗生素的基础上是否应加入口服抗生素,目前仍有争论。本研究采用前瞻性随机对照研究,评估口服抗生素联合MBP在择期腹腔镜结直肠癌(CRC)手术中降低术后吻合口瘘(AL)、手术部位感染(SSI)的有效性及其临床应用价值。方法:前瞻性纳入中南大学湘雅三医院2023年1月—10月符合标准的择期腹腔镜CRC手术患者,随机分成研究组(肠道准备方案为口服抗生素联合MBP)与对照组(肠道准备方案为单纯MBP)。两组术前均常规静脉注射抗生素,由同一组手术医师实施标准腹腔镜下CRC根治术。以术后30 d内AL与SSI发生率为主要指标,比较两种肠道准备方案的疗效差异,并行亚组(右半结肠手术亚组、左半结肠及直肠手术亚组)分析。结果:最终纳入192例患者,每组各96例,两组基线资料具有可比性。研究组的腹腔引流管留置时间、总住院时间、术后住院时间均明显短于对照组(均P<0.05),两组的手术时间、术中出血量、首次排气时间、首次排便时间、饮水进食时间及术后静脉抗生素使用时间差异均无统计学意义(均P>0.05)。研究组术后AL的发生率低于对照组,但差异无统计学意义(3.13%vs.5.21%,P=0.718);研究组术后总体SSI发生率明显低于对照组(6.25%vs.27.08%,P<0.001),且差异主要来自浅表切口性SSI(2.08%vs.11.46%,P=0.010)和深部切口性SSI(1.04%vs.10.42%,P=0.005);两组患者其他并发症发生率以及30 d内再入院率、再手术率、病死率差异均无统计学意义(均P>0.05)。研究组术后1、3 d部分炎症指标优于对照组(均P<0.05)。亚组分析结果显示,两组接受右半结肠手术亚组中,研究组与对照组的AL和总体SSI发生率差异均无统计学意义(均P>0.05);左半结肠及直肠手术亚组中,研究组总体SSI发生率明显低于对照组(6.67%vs.35.00%,P<0.001),且差异主要来自浅表�Background and Aims:There is ongoing debate about whether oral antibiotics should be added to mechanical bowel preparation(MBP)and prophylactic intravenous antibiotics,which are routinely administered before elective colorectal surgery.This study conducted to evaluate the effectiveness and clinical value of combining oral antibiotics with MBP in reducing postoperative anastomotic leakage(AL)and surgical site infections(SSI)in elective laparoscopic colorectal cancer(CRC)surgery using a prospective randomized controlled design.Methods:From January to October 2023 the Third Xiangya Hospital,Central South University,eligible patients scheduled for elective laparoscopic CRC surgery were prospectively enrolled and randomly assigned to either a study group(oral antibiotics combined with MBP)or a control group(MBP alone).All patients received routine preoperative intravenous antibiotics.Standard laparoscopic CRC radical surgery was performed by the same surgical team.Using the incidence rates of AL and SSI within postoperative 30 d as the primary outcomes,the efficacy of the two bowel preparation methods was compared,and subgroup analyses were conducted for patients undergoing right-sided colon surgery and those undergoing left-sided colon or rectal surgery.Results:A total of 192 patients were enrolled,with 96 patients in each group,showing comparable baseline characteristics.The study group had significantly shorter abdominal drain retention time,total hospital stay,and postoperative hospital stay compared to the control group(all P<0.05).No significant differences were observed between the two groups in terms of operative time,intraoperative blood loss,time to first gas passage,time to first bowel movement,time to start drinking and eating,and duration of postoperative intravenous antibiotic use(all P>0.05).The study group had a lower incidence of postoperative AL compared to the control group,but the difference was not statistically significant(3.13%vs.5.21%,P=0.718).The overall SSI rate was significantly lower in the

关 键 词：结直肠外科手术 术前用药法 抗生素预防 吻合口瘘 外科伤口感染 

分 类 号：R656.9[医药卫生—外科学]