机械肠道准备用于选择性结直肠手术:一个多中心随机试验
Caroline M E Contant1, Wim C J Hop, Hans Pieter van't Sant
1Department of Surgery, Ikazia Hospital, Rotterdam, Netherlands. brusselcontant@chello.nl
Lancet (London, England)
|December 25, 2007
概括
在结直肠手术前不需要进行机械性肠道准备,因为它不会影响静脉漏率. 放弃这种做法是安全的,并建议选择性程序.
科学领域:
- 结肠直肠手术 结肠直肠手术
- 手术准备 手术准备
- 临床试验 临床试验
背景情况:
- 机械肠道准备是选择性结直肠手术的标准手术前程序.
- 机械肠道准备对手术结果的必要性和影响仍在争论中.
- 这项研究的目的是评估带有或没有机械肠道制备的静脉漏率.
研究的目的:
- 为了比较选择性结肠直肠切除后的解性泄漏的发生率.
- 为了确定机械肠道制备是否会影响道泄漏的风险.
- 评估遗漏机械肠道制备的安全性和有效性.
主要方法:
- 一个多中心随机非劣势试验,涉及1431名接受选择性结直肠手术的患者.
- 患者被分配到接受机械肠道准备或没有准备 (正常饮食).
- 主要终点是静脉泄漏,随访时间中位数为24天.
主要成果:
- 在两组之间,道泄漏率是相似的:有机械肠道制备的4.8%与没有 (p=0.69) 的5.4%相比.
- 接受机械肠道制备的患者在泄漏后出现的明显减少 (0.3%对2.5%,p=0.001).
- 在其他败血症并发症,伤口枯或死亡率方面没有发现显著差异.
结论:
- 在选择性结直肠手术之前,可以安全地省略机械肠道准备.
- 放弃机械性肠道准备并不会增加道泄漏的风险.
- 这些发现支持改变当前的手术准备方案.
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