目标:在结直肠癌手术中,手术部位感染(SSI)的风险相对较高.SSI的发展与住院时间更长,费用更高,生活质量下降有关;因此,围手术期预防SSI很重要。与单独的MBP相比,化学肠道准备(CBP)与机械肠道准备(MBP)联合可能更有效地预防手术部位感染(SSI)。自2021年5月以来,我们一直口服卡那霉素和甲硝唑作为CBP,除了MBP,作为结直肠癌手术的术前治疗,手术前一天。在这项研究中,我们使用倾向评分匹配(PSM)研究了CBP以及MBP在结直肠癌手术中的临床价值.
方法:从2017年1月至2021年12月,连续136例患者在大阪城市大学医院接受了乙状结肠和直肠癌的根治性手术。将患者分为两组:CBP和N-CBP。在N-CBP组中,我们只做了术前MBP,而在CBP组中,除MBP外,我们进行了术前CBP。我们回顾性分析了这种与PSM的关系。
结果:总体而言,46例患者术前行CBP和MBP,90例患者术前仅行MBP。基于以下十个因素,在CBP组和N-CBP组之间进行PSM:年龄,性别,糖尿病,术前治疗,格拉斯哥预后评分(GPS),手术时间,失血,造口,和病理阶段。PSM之后,对SSI与临床病理因素之间的关系进行了单因素和多因素分析.单因素分析显示年龄和CBP与SSI发生率相关(p=0.039,p=0.017),而性别与SSI发生率相对相关(p=0.066)。对重要因素的多变量分析将75岁或以上的年龄和非CBP确定为切口SSI的独立危险因素(HR=9.5;p=0.049,HR=5.4×e-8;p=0.020)。
结论:术前CBP联合MBP可有效预防结直肠癌手术中的切口SSI。
OBJECTIVE: In colorectal cancer surgery, the risk of surgical site infection (SSI) is relatively high. The development of SSI is related to longer and costlier hospitalization and reduced quality of life; therefore, perioperative prevention of SSI is important. Chemical bowel preparation (CBP) combined with mechanical bowel preparation (MBP) may be more effective in preventing surgical site infection (SSI) compared to MBP alone. Since May 2021, we have been administering oral kanamycin and
metronidazole as CBP, in addition to MBP, as a preoperative treatment for colorectal cancer surgery on the day before surgery. In this study, we investigated the clinical value of CBP in addition to MBP in colorectal cancer surgery using propensity score matching (PSM).
METHODS: From January 2017 to December 2021, 136 consecutive patients underwent radical surgery for sigmoid colon and rectal cancer at the Osaka Metropolitan University Hospital. Patients were divided into two groups: CBP and N-CBP. In the N-CBP group, we performed only preoperative MBP, whereas in the CBP group, we performed preoperative CBP in addition to MBP. We retrospectively analyzed this relationship with PSM.
RESULTS: Overall, 46 patients underwent preoperative CBP and MBP, 90 patients underwent preoperative MBP only. PSM was performed between the CBP and N-CBP groups based on the following ten factors: age, sex, diabetes mellitus, preoperative therapy, Glasgow Prognostic Score (GPS), operative time, blood loss, stoma, and pathological stage. After PSM, univariate and multivariate analyses of the relationship between SSI and clinicopathological factors were performed. Univariate analysis showed that age and CBP were correlated with the rate of SSI (p=0.039 and p=0.017, respectively), whereas sex was relatively correlated with the rate of SSI (p=0.066). The multivariate analysis of significant factors identified age of 75 or more and non-CBP as an independent risk factor for incisional SSI (HR=9.5; p=0.049 and HR=5.4×e-8; p=0.020).
CONCLUSIONS: Preoperative CBP in addition to MBP was effective in preventing incisional SSI during colorectal cancer surgery.