从历史角度看结直肠术前肠道准备争议

doi:10.3877/cma.j.issn.2095-3224.2019.05.013

加速康复外科（ERAS）概念自1999年由丹麦kehlet教授首次提出，其核心理念是在循证医学理念的基础上，对围术期进行一系列处理，减少手术创伤及应激对患者的伤害及体内平衡的干扰，使患者心理和生理状况尽快从手术中恢复，减少术后干扰并发症、缩短住院时间、再入院率。目前ERAS发展极为迅速，各大医疗中心均发展出自己特色的ERAS路径。我们在看到ERAS发展如此之快的同时，更应该注意到在ERAS推行过程中，其与传统理念及习惯的激烈碰撞，进而所产生对ERAS方案的疑问。其中就包括肠道准备。本文将从历史角度并综述国内外现有的关于肠道准备的证据，对肠道准备争议进行探讨。

关键词: 结直肠肿瘤, 加速康复外科, 肠道准备, 历史角度

The concept of enhanced recovery after surgery (ERAS) was first proposed by professor Kehlet of Denmark in 1999. The core idea is to carry out a series of treatments on the perioperative period based on the concept of evidence-based medicine to reduce surgical trauma and stress. The disturbance of homeostasis makes the patient′s psychological and physiological conditions recover from surgery as soon as possible, reducing postoperative interference complications, shortening hospital stay, and re-admission rate. At present, ERAS is developed very rapidly, and all major centers have developed into their own unique ERAS path. While seeing the rapid development of ERAS, we should also pay attention to the fierce collision with traditional ideas and habits during the implementation of ERAS, and then raise questions about the ERAS solution. This paper will review the existing evidence of intestinal preparation at home and abroad and discuss the development of intestinal preparation from a historical perspective.

Key words: Colorectal neoplasms, ERAS, Bowel preparation, Historical perspective

[1]	Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation [J]. British Journal of Anaesthesia, 1997, 78(5): 606-617.
[2]	Senturk JC, Kristo G, Gold J, et al. The development of enhanced recovery after surgery across surgical specialties [J]. Journal of Japaroendoscopic & Advanced Surgical Techniques. Part A, 2017, 27(9): 863-870.
[3]	Forsmo HM, Erichsen C, Rasdal A, et al. Randomized controlled trial of extended Perioperative counseling in enhanced recovery after colorectal surgery [J]. Diseases of The Colon and Rectum, 2018, 61(6): 724-732.
[4]	Hahl T, Peromaa-Haavisto P, Tarkiainen P, et al. Outcome of laparoscopic gastric bypass (LRYGB) with a program for enhanced recovery after surgery (ERAS) [J]. Obesity Surgery, 2016, 26(3): 505-511.
[5]	Kaslow SR, Gani F, Alshaikh HN. Clinical outcomes following mechanical plus oral antibiotic bowel preparation versus oral antibiotics alone in patients undergoing colorectal surgery [J]. BJS Open, 2018, 2(4): 238-245.
[6]	Kang SH, Lee Y, Min SH, et al. Multimodal Enhanced Recovery After Surgery (ERAS) program is the optimal perioperative care in patients undergoing totally laparoscopic distal gastrectomy for gastric cancer: a prospective randomized clinical trial [J]. Annals of Surgical Oncology, 2018, 25(11): 3231-3238.
[7]	Ren L, Zhu D, Wei Y, et al. Enhanced recovery after surgery (ERAS) program attenuates stress and accelerates recovery in patients after radical resection for colorectal cancer: a prospective randomized controlled trial [J]. World Journal of Surgery, 2012, 36(2): 407-414.
[8]	Lee L, Mata J, Ghitulescu GA, et al. Cost-effectiveness of enhanced recovery versus conventional perioperative management for colorectal surgery [J]. Annals of Surgery, 2015, 262(6): 1026-1033.
[9]	Miller TE, Thacker JK, White WD, et al. Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol [J]. Anesthesia and Analgesia, 2014, 118(5): 1052-1061.
[10]	Poth EJ. Historical development of intestinal antisepsis [J]. World Journal of Surgery, 1982, 6(2): 153-159.
[11]	Nichols RL, Broido P, Condon RE, et al. Effect of preoperative neomycin-erythromycin intestinal preparation on the incidence of infectious complications following colon surgery [J]. Annals of Surgery, 1973, 178(4): 453-462.
[12]	Irving AD, Scrimgeour D. Mechanical bowel preparation for colonic resection and anastomosis [J]. The British Journal of Surgery, 1987, 74(7): 580-581.
[13]	Mahajna A, Krausz M, Rosin D, et al. Bowel preparation is associated with spillage of bowel contents in colorectal surgery [J]. Diseases of The Colon and Rectum, 2005, 48(8): 1626-1631.
[14]	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 [J]. Diseases of The Colon and Rectum, 1998, 41(5): 636-641.
[15]	Poole GA. Spontaneous bacterial peritonitis during bowel preparation: an example of clinical translocation [J]. Southern Medical Journal, 1991, 84(11): 1412-1413.
[16]	Cannon JA, Altom LK, Deierhoi RJ, et al. Preoperative oral antibiotics reduce surgical site infection following elective colorectal resections [J]. Diseases of the Colon and Rectum, 2012, 55(11): 1160-1166.
[17]	Bellows CF, Mills KT, Kelly TN, et al. Combination of oral non-absorbable and intravenous antibiotics versus intravenous antibiotics alone in the prevention of surgical site infections after colorectal surgery: a meta-analysis of randomized controlled trials [J]. Techniques In Coloproctology, 2011, 15(4): 385-395.
[18]	Contant CM, Hop WC, van′t Sant HP, et al. Mechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial [J]. Lancet (London, England), 2007, 370(9605): 2112-2117.
[19]	Kiran RP, Murray AC, Chiuzan C, et al. Combined preoperative mechanical bowel preparation with oral antibiotics significantly reduces surgical site infection, anastomotic leak, and ileus after colorectal surgery [J]. Annals of Surgery, 2015, 262(3): 416-425; discussion 423-415.
[20]	Scarborough JE, Mantyh CR, Sun Z, et al. Combined mechanical and oral antibiotic bowel preparation reduces incisional surgical site infection and anastomotic leak rates after elective colorectal resection: an analysis of colectomy-targeted acs nsqip [J]. Annals of Surgery, 2015, 262(2): 331-337.
[21]	Slim K, Vicaut E, Panis Y, et al. Meta-analysis of randomized clinical trials of colorectal surgery with or without mechanical bowel preparation [J]. The British Journal of Surgery, 2004, 91(9): 1125-1130.
[22]	Bucher P, Gervaz P, Soravia C, et al. Randomized clinical trial of mechanical bowel preparation versus no preparation before elective left-sided colorectal surgery [J]. The British Journal of Surgery, 2005, 92(4): 409-414.
[23]	Guenaga KF, Matos D, Wille-Jorgensen P. Mechanical bowel preparation for elective colorectal surgery [J]. The Cochrane Database of Systematic Reviews, 2011, 10.1002/14651858.CD001544.pub4(9):CD001544.
[24]	Collin A, Jung B, Nilsson E, et al. Impact of mechanical bowel preparation on survival after colonic cancer resection [J]. The British Journal of Surgery, 2014, 101(12): 1594-1600.
[25]	Kodeda K, Holmberg E, Jorgren F, et al. Rectal washout and local recurrence of cancer after anterior resection [J]. The British Journal of Surgery, 2010, 97(10): 1589-1597.
[26]	Matsuda A, Kishi T, Musso G, et al. The effect of intraoperative rectal washout on local recurrence after rectal cancer surgery: a meta-analysis [J]. Annals of Surgical Oncology, 2013, 20(3): 856-863.
[27]	Beyer-Berjot L, Slim K. Colorectal surgery and preoperative bowel preparation: aren′t we drawing hasty conclusions? [J]. Colorectal Disease: The Official Journal of The Association of Coloproctology of Great Britain and Ireland, 2018, 10.1111/codi.14415.
[28]	Toh JWT, Phan K, Ctercteko G, et al. The role of mechanical bowel preparation and oral antibiotics for left-sided laparoscopic and open elective restorative colorectal surgery with and without faecal diversion [J]. International Journal of Colorectal Disease, 2018, 33(12): 1781-1791.
[29]	Yost MT, Jolissaint JS, Fields AC, et al. Mechanical and oral antibiotic bowel preparation in the era of minimally invasive surgery and enhanced recovery [J]. Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A, 2018, 28(5): 491-495.
[30]	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 [J]. Diseases of The Colon And Rectum, 2005, 48(8): 1509-1516.
[31]	Miettinen RP, Laitinen ST, Makela JT, et al. Bowel preparation with oral polyethylene glycol electrolyte solution vs. no preparation in elective open colorectal surgery: prospective, randomized study [J]. Diseases of The Colon and Rectum, 2000, 43(5): 669-675; discussion 675-667.
[32]	Jung B, Pahlman L, Nystrom PO, et al. Multicentre randomized clinical trial of mechanical bowel preparation in elective colonic resection [J]. The British Journal of Surgery, 2007, 94(6): 689-695.
[33]	Platell C, Barwood N, Makin G. Randomized clinical trial of bowel preparation with a single phosphate enema or polyethylene glycol before elective colorectal surgery [J]. The British Journal of Surgery, 2006, 93(4): 427-433.
[34]	Englesbe MJ, Brooks L, Kubus J, et al. A statewide assessment of surgical site infection following colectomy: the role of oral antibiotics [J]. Annals of Surgery, 2010, 252(3): 514-519; discussion 519-520.
[35]	Al-Mazrou AM, Hyde LZ, Suradkar K, et al. Effect of inclusion of oral antibiotics with mechanical bowel preparation on the risk of clostridium dfficile infection after colectomy [J]. J Gastrointest Surg, 2018, 22(11): 1968-1975.
[36]	Janssen Lok M, Miyake H, O′Connell JS, et al. The value of mechanical bowel preparation prior to pediatric colorectal surgery: a systematic review and meta-analysis [J]. Pediatr Surg Int, 2018, 34(12): 1305-1320.
[37]	Alfonsi P, Slim K, Chauvin M, et al. French guidelines for enhanced recovery after elective colorectal surgery [J]. Journal of Visceral Surgery, 2014, 151(1): 65-79.
[38]	何干, 陈凯, 刘洋, 等. 结直肠择期手术前机械性肠道准备必要性的Meta分析[J]. 中国老年学杂志, 2017, 37(8): 1959-1962.
[39]	王磊, 马腾辉. 腹腔镜结直肠手术需要常规肠道准备[J]. 中华胃肠外科杂志, 2017, 20(6): 644-645.
[40]	陈凛, 陈亚进, 董海龙, 等. 加速康复外科中国专家共识及路径管理指南(2018版) [J]. 中国实用外科杂志, 2018, 38(1): 1-20.
[41]	何红梅, 王亚旭. 大肠癌患者术前肠道准备的研究现状 [J]. 现代医药卫生, 2016, 32(7): 1029-1031.

[1]	罗青杉, 梅海涛, 郝家领, 蔡锦锋, 周润楷, 温玉刚. 连接蛋白43通过调控细胞周期抑制结直肠癌的增殖机制研究[J/OL]. 中华普通外科学文献(电子版), 2024, 18(05): 344-349.
[2]	徐逸男. 不同术式治疗梗阻性左半结直肠癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 72-75.
[3]	严虹霞, 王晓娟, 张毅勋. 2 型糖尿病对结直肠癌患者肿瘤标记物、临床病理及预后的影响[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 483-487.
[4]	赵磊, 刘文志, 林峰, 于剑, 孙铭骏, 崔佑刚, 张旭, 衣宇鹏, 于宝胜, 冯宁. 深部热疗在改善结直肠癌术后辅助化疗副反应及生活质量中的作用研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 488-493.
[5]	黄海洋, 邝永龙, 陈嘉胜. 基层医院结直肠肿瘤经自然腔道取标本手术30 例分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 510-518.
[6]	韩加刚, 王振军. 梗阻性左半结肠癌的治疗策略[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 450-458.
[7]	梁轩豪, 李小荣, 李亮, 林昌伟. 肠梗阻支架置入术联合新辅助化疗治疗结直肠癌急性肠梗阻的疗效及其预后的Meta 分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 472-482.
[8]	任佳琪, 刁德昌, 何自衍, 张雪阳, 唐新, 李文娟, 李洪明, 卢新泉, 易小江. 网膜融合线导向的脾曲游离技术在左半结肠癌根治术中的应用[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 362-367.
[9]	张迪, 王春霞, 张学东, 李发馨, 庞淅文, 陈一锋, 张维胜, 王涛. 梗阻性左半结直肠癌自膨式金属支架置入后行腹腔镜手术与开腹手术的短期临床疗效比较[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 375-380.
[10]	张蔚林, 王哲学, 白峻阁, 黄忠诚, 肖志刚. 利用TCGA数据库构建基于miRNA的结直肠癌列线图预后模型[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 381-388.
[11]	张伟伟, 陈启, 翁和语, 黄亮. 随机森林模型预测T1 期结直肠癌淋巴结转移的初步研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 389-393.
[12]	季鹏程, 鄂一民, 陆晨, 喻春钊. 循环外泌体相关生物标志物在结直肠癌诊断中的研究进展[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(04): 265-273.
[13]	李佳莹, 王旭丹, 梁雪, 张雷, 李佳英. 1990~2021年中国结直肠癌死亡趋势分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(04): 274-279.
[14]	戈伟, 陈刚. 纳米炭导航行淋巴示踪在结直肠癌TNM分期中淋巴分期价值的临床研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(04): 288-293.
[15]	崔精, 鲍一帆, 沈晓明, 杨增辉, 高森, 鲍传庆. 结直肠癌中circMFSD12对肿瘤细胞功能及5-FU敏感性的调控[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(04): 294-302.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

A historical perspective on the controversy of preoperative bowel preparation in colorectal surgery

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

A historical perspective on the controversy of preoperative bowel preparation in colorectal surgery