摘要
通过前瞻性、随机对照研究评价腹腔镜结直肠癌根治术前应用大黄溶液灌肠代替传统机械性肠道准备的安全性及其促进术后胃肠道功能恢复的疗效,为中医药加速腹部术后胃肠功能恢复提供循证医学证据.纳入2018年12月~2021年4月来自首都医科大学附属北京中医医院大外科及肿瘤外科行腹腔镜下结直肠癌根治术患者237例,分为传统机械性肠道准备组和大黄溶液灌肠肠道准备组,观察两组首次排气时间、首次排便时间、肠鸣音恢复时间、住院时间及术后住、术后第五天的生活质量评分、术后第一天及第五天的腹痛及腹胀程度、肠道功能评估、手术相关并发症等指标.术前大黄溶液灌肠肠道准备组的患者术后肠鸣音恢复时间及术后首次排便时间较传统机械性肠道准备组明显缩短且差异具有统计学意义(P<0.05),术后首次排气时间短于传统机械性肠道准备组,但差异性无统计学意义(P>0.05).术前大黄溶液灌肠肠道准备组患者术后胃管拔除时间较传统机械性肠道准备组提前(术后第五天生活质量评分也明显优于传统机械性肠道准备组(P<0.05)).大黄溶液灌肠肠道准备组住院天数短于传统机械性肠道准备组,但差异无明显统计学意义(P>0.05).术前大黄灌肠肠道准备替代传统机械性肠道准备有效缓解术后第一天和术后第五天患者的腹胀程度,减轻术后第五天的胃肠道反应(P<0.05).但是对于患者术后第一天的胃肠道反应以及术后第一天和第五天的腹痛程度无明显缓解作用(P>0.05).另外两组患者术后第一天和第五天白细胞计数相似,不具备统计学意义(P>0.05),但是大黄溶液灌肠肠道准备组患者术后第一天C-反应蛋白表达量明显低,且差异性具有明显统计学意义(P<0.01),两组术后第五天两组患者C-反应蛋白表达量相似,无统计学意义(P>0.05).两组手术相关并发症,如术后切口感染、肠梗阻等并无显著差异(P>0.05).腹腔镜结直肠癌根治手术前应用大黄溶液灌肠肠道准备,在清洁肠道的同时加速患者术后肠鸣音恢复、缩短首次排便及留置胃管的时间,一定程度上缓解术后腹胀、胃肠反应,且并未增加手术相关并发症,提高患者术后生活质量,加速患者康复.
A prospective,randomized controlled study was conducted to evaluate the safety and efficacy of rhubarb solution enema compared to traditional mechanical intestinal preparation before laparoscopic radical resection of colorectal cancer and provide evidence-based medical evidence for traditional Chinese medicine to accelerate recovery of gastrointestinal functions after abdominal surgery.A total of 237 patients who underwent laparoscopic radical resection of colorectal cancer from December 2018 to April 2021 at the Department of General Surgery and Tumor Surgery of Beijing Traditional Chinese Medicine Hospital,affiliated with Capital Medical University,were included.The patients were divided into two groups:traditional mechanical intestinal preparation and rhubarb solution enema groups.The first exhaust time,first defecation time,bowel sound recovery time,hospitalization time and postoperative stay,quality-of-life score on the fifth postoperative day,degree of abdominal pain and bloating on the first and fifth postoperative days,evaluation of intestinal function,and surgical-related complications in both groups were observed.Patients in the preoperative application of rhubarb solution enema intestinal preparation group had significantly shorter postoperative bowel sound recovery and first postoperative defecation times than those in the traditional mechanical intestinal preparation group,and the difference was statistically significant(P<0.05).The first postoperative exhaust time for the rhubarb solution enema group was shorter than that for the traditional mechanical intestinal preparation group,but the difference was not statistically significant(P>0.05).The time for gastric tube removal was earlier in the preoperative rhubarb solution enema intestinal preparation group than in the traditional mechanical intestinal preparation group,and the quality-of-life score on the fifth postoperative day was significantly higher(P<0.05).The hospitalization days of the rhubarb solution enema intestinal preparation group were lesser than those of the traditional mechanical intestinal preparation group,but the difference was not statistically significant(P>0.05).Compared with traditional mechanical intestinal preparation,preoperative rhubarb enema intestinal preparation effectively alleviated abdominal distension in patients on the first and fifth postoperative days and reduced gastrointestinal reactions on the fifth postoperative day(P<0.05).However,there was no significant relief effect on the patients’gastrointestinal response on the first postoperative day or on the degree of abdominal pain on the first and fifth postoperative days(P>0.05).The other two groups of patients had comparable white blood cell counts on the first and fifth postoperative days,which were not statistically significant(P>0.05).However,Creactive protein expression was significantly lower in the rhubarb solution enema intestinal preparation group on the first postoperative day,and the difference was statistically significant(P<0.01).The expression of C-reactive protein in both groups of patients on the fifth postoperative day was similar but not statistically significant(P>0.05).There was no significant difference between the two groups in surgical-related complications,such as postoperative incision infection and intestinal obstruction(P>0.05).The use of rhubarb solution enema for intestinal preparation before laparoscopic radical surgery for colorectal cancer cleans the intestines,accelerates recovery of postoperative bowel sounds,shortens the time for first defecation and indwelling gastric tubes,and,to an extent,alleviates postoperative abdominal distension and gastrointestinal reactions without increasing surgical-related complications.This improves patients’quality of life after surgery and accelerates their recovery.
作者
于淼
裴晓华
路夷平
YU Miao;PEI XiaoHua;LU YiPing(Department of Oncology Surgery,Capital University of Medical Sciences affiliated Beijing Hospital of Traditional Chinese Medicine,Beijing 100010,China;Xiamen Hospital of Traditional Chinese Medicine/Xiamen Hospital,Beijing University of Chinese Medicine/Xiamen TCM Hospital Affiliated to Fujian University of Traditional Chinese Medicine,Xiamen 361015,China)
出处
《中国科学：生命科学》
CSCD
北大核心
2024年第7期1292-1303,共12页
Scientia Sinica(Vitae)
基金
国家重点研发计划(批准号:2019YFC712000)资助。
关键词
腹腔镜结直肠肿瘤根治术
术前肠道准备
大黄
中药灌肠
胃肠功能恢复
中医加速康复外科
laparoscopic radical resection of colorectal tumor
preoperative bowel preparation
rhubarb
traditional Chinese materia medica enema
gastrointestinal function recovery
traditional Chinese medicine enhanced rehabilitation surgery
