摘要
对于结直肠癌的择期手术,最新的循证医学证据支持术前机械性肠道准备联合口服抗生素。由于患者肠道通畅程度各异,需要实施个体化术前肠道准备方案,以避免不良事件。本文概要介绍相关高级别证据、指南和共识更新,并结合本中心的实践经验作出以下分层推荐:(1)无进食受限、肠镜可通过肿瘤的患者,可行机械性肠道准备和预防性口服抗生素;(2)无典型梗阻症状,但因肿瘤肠段狭窄导致进食受限或肠镜不可通过的患者,建议术前数日开始口服小剂量缓泻药至手术前夕,并在术前预防性口服抗生素;(3)梗阻患者无须术前机械性肠道准备或灌肠。
For elective surgery of colorectal cancer,current evidence supports preoperative mechanical bowel preparation combined with oral antibiotics.Meanwhile,for patients with varied degrees of intestinal stenosis,individualized protocol is required to avoid adverse events.We hereby summarize recent high-quality evidences and updates of guidelines and consensus,and recommend stratified bowel preparation based on the clinical practice of our institute as follows.(1)For patients with unimpaired oral intake,whose tumor can be passed by colonoscopy,mechanical bowel preparation and oral antibiotics are given.(2)For patients without symptoms of bowel obstruction but with impaired oral intake or incomplete colonoscopy due to tumor-related stenosis,small-dosage laxative is given for several days before surgery,and oral antibiotics the day before surgery.(3)For patients with bowel obstruction,mechanical bowel preparation or enema is not indicated.We proposed this evidence-based,individualized protocol for preoperative bowel preparation for the reference of our colleagues,in the hope of improving perioperative outcomes and reducing adverse events.
作者
窦若虚
周佐霖
汪建平
Ruoxu Dou;Zuolin Zhou;Jianping Wang(Department of Colorectal Surgery,the Sixth Affiliated Hospital of Sun Yat-sen University,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor,Guangdong Institute of Gastroenterology,Guangzhou 510655,China;Department of Gastrointestinal Surgery,the fifth Affiliated Hospital of Sun Yat-sen University,Zhuhai 519000,China)
出处
《中华胃肠外科杂志》
CSCD
北大核心
2022年第7期645-647,共3页
Chinese Journal of Gastrointestinal Surgery
关键词
结直肠肿瘤
择期手术
肠道准备
肠梗阻
Colorectal neoplasms
Elective surgery
Bowel preparation
Bowel obstruction
