Медицинская литература. Новинки

 

 

 

 

 

 

Значение предоперационной механической подготовки кишки в плановой колоректальной хирургии

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Механическая подготовка кишки к операциям стала рутинной практикой. Цель работы: изучить существующие в современной литературе данные об эффективности и безопасности подготовки кишки перед плановыми операциями на толстой кишке. Были проанализированы результаты 7 проспективных рандомизированных исследований, в которых сравнивали результаты лечения плановых колопроктологических больных с использованием предоперационной подготовки кишки и без нее. Общее число больных составило 2608. Предоперационная подготовка проведена 1318 пациентам, 1290 больных оперированы без подготовки. Летальность в сравниваемых группах не отличалась. Частота несостоятельности анастомоза и гнойных осложнений была несколько выше в группе больных, получивших подготовку кишки, но различия были статистически недостоверными. Использование современных хирургических технологий позволяет в большинстве наблюдений безопасно отказаться от механической предоперационной подготовки кишки. Необходимость проведения предоперационной подготовки и ее вид нуждаются в дальнейшем изучении.

Ключевые слова:
Предоперационная подготовка кишечника, колоректальная хирургия.

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Mechanical Bowel Preparation for Elective Colorectal Surgery

Mechanical bowel preparation has been considered an efficient measure against anastomotic leakage and infections complications in elective colorectal surgery. Purpose: to determine the effectiveness and safety of mechanical bowel preparation in coloproctology. Methods: the computerized searches of publications describing mechanical bowel preparation before elective colorectal surgery in electronic libraries. Selection criteria: randomised clinical trials, comparing groups of patients with or without mechanical bowel preparation. Outcome measures: anastomotic leakage, infectious complications, mortality. Results: Overall 2608 patients were analyzed. 1318 of them were allocated for mechanical bowel preparation and 1290 for no preparation before elective colorectal surgery. Mortality rate did not differ significantly in comparing groups. Anastomotic leakage and surgical site infections rates were higher in bowel preparation group, but the differences were not significant. Conclusions: The results of our review failed to support the hypothesis that bowel preparation reduces anastomotic leak rates and other complications. The routine use of mechanical bowel preparation in patients undergoing elective colorectal surgery is questioned.

Keywords:
Bowel preparation, colorectal surgery.