与选择性结肠直肠手术前机械性肠准备相关的形态学变化:一项随机化试验

作     者：Bucher P. Gervaz P. Egger J. -F. 郑世成(译) 王顺涛(校) 

作者机构：Department of Surgery Geneva University Hospital 24 Rue Micheli-du-Crest 1211 Geneva 14 Switzerland 不详 

出 版 物：《世界核心医学期刊文摘（胃肠病学分册）》 (Core Journals in Gastroenterology)

年 卷 期：2006年第2卷第6期

页      面：22-23页

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 100212[医学-眼科学] 10[医学] 

主　　题：随机试验研究 直肠手术 结肠切除 形态学变化 机械性 随机化 严重程度 组织学改变 显著性差异 

摘      要：PURPOSE: The feasibility and safety of left-sided colorectal procedures with avoidance of mechanical bowel preparation has recently been demonstrated. Moreover, mechanical preparation has been associated with an increased risk for abdominal septic complications, including anastomotic leakage. This study was designed to determine whether mechanical bowel preparation is associated with histologic alterations in the colon. METHODS: Fifty patients (mean age, 61 (range, 45-78) years) scheduled to undergo elective colorectal surgery were prospectively randomized to receive mechanical preparation (polyethylene glycol; Group 1) or no preparation (Group 2) preoperatively. A macroscopically healthy segment of the bowel was excised at the proximal margin of the colectomy piece. A pathologist, blinded to the patient’s group allocation, assessed various morphologic parameters. RESULTS: Indications for colectomy (cancer and complicated diverticulosis) did not differ between groups. Bowel wall alterations were more frequent in patients who received a preparation. The most striking alterations associated with mechanical preparation were loss of superficial mucus (moderate-to-severe in 96 and 52 percent in Groups 1 and 2, respectively; P 0.001) and epithelial cells (moderate-to severe in 88 and 40 percent in Groups 1 and 2, respectively; P 0.01). In addition, inflammatory changes, i.e., lymphocytes (severe in 48 and 12 percent in Groups 1 and 2, respectively; P 0.02) and polymorphonuclear cells infiltration (severe in 52 and 8 percent in Groups 1 and 2, respectively; P 0.02), were more prevalent after mechanical preparation. CONCLUSIONS: Mechanical bowel preparation is associated with structural alteration and inflammatory changes in the large bowel wall. Although bowel wall inflammation is a known risk factor for anastomotic leak, it remains to be elucidated whether these changes have a direct relation to the deleterious effect of mechanical bowel preparation in terms of abd