Comparison of different bowel preparation methods in radical cystectomy and ileal conduit
-
摘要:目的 比较3种全肠道清洁方法应用于根治性膀胱切除并回肠膀胱术前肠道准备的效果。方法 选择2012年3月—2018年11月行根治性膀胱切除并回肠膀胱术的46例患者作为研究对象，其中2012年3月—2016年2月的患者设为A组, 2016年3月—2018年1月的患者设为B组, 2018年2—11月的患者设为C组, A组术前接受传统肠道准备(TBP), B组术前接受快速肠道准备(RBP), C组术前接受肠内营养(EN)。比较3组患者术后肠道功能恢复时间、肠道清洁度、耐受性及不良反应的差异。结果 C组患者的术后肠道恢复蠕动时间、术后通气时间均优于A组、B组患者，差异有统计学意义(P < 0.05); 3组患者术中肠道清洁度比较，差异无统计学意义(P>0.05); A组、B组患者术后并发症发生率比较，差异无统计学意义(P>0.05)。结论 RBP方案应用于膀胱根治性切除并回肠膀胱术前肠道准备中安全有效, EN方案的肠道清洁度与TBP、RBP方案基本一致，但在患者可耐受性、术后肠道蠕动恢复时间、术后肛门排气时间方面均优于TBP、RBP方案，推荐用于膀胱根治性切除并回肠膀胱术前的肠道准备。Abstract:Objective To compare the effect of three bowel preparation methods in radical cystectomy and ileal cystoplasty.Methods A total of 46 patients scheduled for radical cystectomy and ileal conduit from March 2012 to November 2018 were selected as study objects, and were divided into group A [from March 2012 to February 2016, traditional bowel preparation (TBP)], group B [from March 2016 to January 2018, rapid bowel preparation (RBP)], and group C [from February to November 2018, enteral nutrition (EN)]. The recovery time of intestinal function, intestinal cleanliness, tolerance and adverse reactions were compared among the three groups.Results The recovery time of intestinal function in group C were significantly better than the other two groups(P < 0.05). No significant difference was found in intestinal clearance in three groups and postoperative complications between group A and group B(P>0.05).Conclusions RBP method is safe and effective in preoperative bowel preparation for radical cystectomy and ileal conduit. EN method is as the same efficacy as the TBP and RBP in intestinal clearance, but is better in terms of time to flatus and bowel movement as well as tolerance than TBP and RBP, and can be recommended to as bowel preparationbefore radical cystectomy and ileal conduit.
-
Keywords:
- bladder cancer /
- ileal conduit /
- bowel preparation /
- rehabilitation
-
-
表 1 3组患者的临床特征及手术指标比较(±s)[n(%)]
指标 A组(n=24) B组(n=18) C组(n=4) 性别 男 18(75.00) 16(88.89) 3(75.00) 女 6(25.00) 2(11.11) 1(25.00) 年龄 <65岁 15(62.50) 8(44.44) 2(50.00) ≥65岁 9(37.50) 10(55.56) 2(50.00) 手术时间/min 100.07±14.42 93.36±11.87 92.55±9.17 通气时间/h 67.51±6.27* 59.22±6.10* 48.25±4.16 术后肠道蠕动时间/h 48.57±2.87* 47.01±3.04* 42.95±40.13 术后至出院时间/d 9.53±1.04 9.24±0.94 8.50±0.41 与C组比较, *P < 0.05。 
下载: 导出CSV
表 2 3组患者肠道清洁度和舒适度指标结果比较[n(%)]
指标 A组(n=24) B组(n=18) C组(n=4) 肠道清结度 高度 21(87.50) 17(94.44) 2(50.00) 中度 3(12.50) 1(5.56) 2(50.00) 低度 0 0 0 舒适度指标 术前肛门不适 18(75.00)*# 3(16.67)* 0 术前恶心、呕吐 1(4.17)*# 4(22.22)* 0 术后胀气 14(58.33)* 6(33.33)* 1(25.00) 术后腹泻 3(12.50)* 2(11.11)* 0 与C组比较, *P < 0.05; 与B组比较, #P < 0.05。
下载: 导出CSV
表 3 3组患者术后并发症情况比较[n(%)]
组别 n 伤口感染 吻合口瘘 肠梗阻 A组 24 2(8.33) 1(4.17) 1(4.17) B组 18 1(5.56) 0 1(5.56) C组 4 0 0 0
下载: 导出CSV
-
[1] Plumley P F. A simple regime for preparation of colon before large-bowel surgery[J]. Br J Surg, 1966, 53(5): 413-414. http://www.ncbi.nlm.nih.gov/pubmed/4952337
[2] Jung B, Påhlman L, Nyström P O, et al. Multicentre randomized clinical trial of mechanical bowel preparation in elective colonic resection[J]. Br J Surg, 2007, 94(6): 689-695. doi: 10.1002/bjs.5816
[3] Contant C M, Hop W C, van't Sant H P, et al. Mechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial[J]. Lancet, 2007, 370(9605): 2112-2117. doi: 10.1016/S0140-6736(07)61905-9
[4] Xu R, Zhao X K, Zhong Z H, et al. No advantage is gained by preoperative bowel preparation in radical cystectomy and ileal conduit: a randomized controlled trial of 86 patients[J]. Int Urol Nephrol, 2010, 42(4): 947-950. doi: 10.1007/s11255-010-9732-9
[5] 梁天才, 王敏, 梁国标, 等. 腹腔镜根治性膀胱全切+原位回肠新膀胱术治疗浸润性膀胱癌[J]. 中国内镜杂志, 2017, 23(1): 74-79. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGNJ201701015.htm [6] 何大鹏, 谢习颂, 王咸钟, 等. 腹腔镜根治性膀胱癌切除术后行回肠膀胱术和输尿管皮肤造口术的疗效比较[J]. 实用癌症杂志, 2017, 32(6): 999-1001. doi: 10.3969/j.issn.1001-5930.2017.06.038 [7] Raynor M C, Lavien G, Nielsen M, et al. Elimination of preoperative mechanical bowel preparation in patients undergoing cystectomy and urinary diversion[J]. Urol Oncol, 2013, 31(1): 32-35. doi: 10.1016/j.urolonc.2010.11.002
[8] Large M C, Kiriluk K J, DeCastro G J, et al. The impact of mechanical bowel preparation on postoperative complications for patients undergoing cystectomy and urinary diversion[J]. J Urol, 2012, 188(5): 1801-1805. doi: 10.1016/j.juro.2012.07.039
[9] Hashad M M, Atta M, Elabbady A, et al. Safety of no bowel preparation before ileal urinary diversion[J]. BJU Int, 2012, 110(11 Pt C): E1109-E1113. doi: 10.1111/j.1464-410X.2012.11415.x/abstract
[10] Matro R, Negoianu D, Kastenberg D. Editorial: hyponatremia - a possible but forgotten consequence of bowel preparation for colonoscopy; authors'reply[J]. Aliment Pharmacol Ther, 2014, 40(9): 1112-1115. doi: 10.1111/apt.12941
[11] Hassan C, Bretthauer M, Kaminski M F, et al. Bowel preparation for colonoscopy: European society of gastrointestinal endoscopy (ESGE) guideline[J]. Endoscopy, 2013, 45(2): 142-150. doi: 10.1055/s-0032-1326186
[12] Younes A, Alliot C, Mokili B, et al. Solvent extraction of polonium(Ⅳ) with tributylphosphate (TBP)[J]. Solvent Extr Ion Exch, 2017, 35(2): 77-90. doi: 10.1080/07366299.2017.1279917
[13] Arnold M, Sierra M S, Laversanne M, et al. Global patterns and trends in colorectal cancer incidence and mortality[J]. Gut, 2017, 66(4): 683-691. doi: 10.1136/gutjnl-2015-310912
计量
- 文章访问数: 206
- HTML全文浏览量: 102
- PDF下载量: 6
苏公网安备 32100302010246号
