• 1.中山大學(xué)附屬第六醫(yī)院(附屬胃腸肛門醫(yī)院)結(jié)直腸外科 Ⅱ 區(qū)(廣州 510655);;
  • 2.解放軍第157醫(yī)院普外科(廣州 510510);

目的 　探討3 d腸道準備和1 d腸道準備對結(jié)直腸癌患者術(shù)前腸屏障功能的影響及臨床意義。
方法 　檢測經(jīng)3 d腸道準備(50例)和經(jīng)1 d腸道準備(50例)的結(jié)直腸癌患者術(shù)前2 h血漿D-乳酸（D-LAC）、二胺氧化酶（DAO）及內(nèi)毒素（ET）水平，25例腹股溝疝患者作為對照。用酶學(xué)分光度法檢測D-LAC濃度，分光度法檢測DAO活性，基質(zhì)偶氮顯色鱟試驗法檢測ET濃度。
結(jié)果 　3 d腸道準備患者術(shù)前2 h血漿D-LAC濃度為(10.25±1.43) mg/L、DAO活性為(5.82±0.80) U/ml、ET濃度為(10.11±1.41) ng/L，1 d腸道準備患者術(shù)前2 h血漿D-LAC濃度為(10.19±1.35) mg/L、DAO活性為(5.80±0.81) U/ml、ET濃度為(9.82±1.35) ng/L，3 d腸道準備者和1 d腸道準備者相應(yīng)結(jié)果比較，差異均無統(tǒng)計學(xué)意義（P gt;0.05），3 d腸道準備和1 d腸道準備的結(jié)直腸癌患者與腹股溝疝患者比較，差異也無統(tǒng)計學(xué)意義（P gt;0.05）。
結(jié)論 　3 d 腸道準備和1 d腸道準備對結(jié)直腸癌患者術(shù)前腸屏障功能均無明顯損害，結(jié)直腸癌患者術(shù)前可行1 d腸道準備，特殊患者仍可用3 d 腸道準備。

引用本文： 謝尚奎,任東林,吳印愛,彭慧,康亮,王曉學(xué),蘇丹. 兩種腸道準備對結(jié)直腸癌患者術(shù)前腸屏障功能的影響. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(9): 710-713. doi: 復(fù)制

1. Zmora O, Pikarsky AJ, Wexner SD. Bowel preparation for colorectal surgery [Ｊ]. Dis Colon Rectum, 2001; 44（10）: 1537-1549.
2. Fa-Si-Oen P, Roumen R, Buitenweg J, et al. Mechanical bowel preparation or not? Outcome of a multicenter, randomized trial in elective open colon surgery [Ｊ]. Dis Colon Rectum, 2005; 48（8）: 1509-1516.
3. 顧晉. 結(jié)直腸腫瘤外科醫(yī)生觀念的轉(zhuǎn)變 [Ｊ]. 中國實用外科雜志, 2005; 25（10）: 585-587.
4. 毛一雷, 盧欣. 從腸粘膜屏障角度評價結(jié)直腸手術(shù)前腸道準備 [Ｊ]. 中國醫(yī)學(xué)科學(xué)院學(xué)報, 2004; 26(5): 591-594.
5. 謝松, 孟榮貴, 于恩達， 等. 選擇性結(jié)直腸手術(shù)前三種腸道準備方案的對照研究 [Ｊ]. 中華普通外科雜志， 2002; 17（2）: 69-71.
6. Smith SM, Eng RH, Campos JM, et al. D-lactic acid measurements in the diagnosis of bacterial infections [Ｊ]. J Clin Microbiol, 1989; 27(3): 385-388.
7. Bragg LE, Thompson JS, West WW. Intestinal diamine oxidase levels reflect ischemic injury [Ｊ]. J Surg Res, 1991; 50(3): 228-233.
8. Buttenschoen K, Berger D, Hiki N, et al. Plasma concentrations of endotoxin and antiendotoxin antibodies in patients with multiple injuries: a prospective clinical study [Ｊ]. Eur J Surg, 1996; 162(11): 853-860.
9. Nichols RL, Smith JW, Garcia RY, et al. Current practices of preoperative bowel preparation among North American colorectal surgeons [Ｊ]. Clin Infect Dis, 1997； 24(4): 609-619.
10. 謝尚奎, 吳印愛, 劉獻棠, 等. 直腸癌保肛術(shù)中行吻合口上下雙管引流效果的觀察 [Ｊ].中國普外基礎(chǔ)與臨床雜志, 2001; 8(1): 47-48.
11. Oliveira L, Wexner SD, Daniel N, et al. Mechanical bowel preparation for elective colorectal surgery. A prospective, randomized, surgeon-blinded trial comparing sodium phosphate and polyethylene glycol-based oral lavage solutions [Ｊ]. Dis Colon Rectum, 1997; 40(5): 585-591.
12. Zmora O, Mahajna A, Bar-Zakai B, et al. Colon and rectal surgery without mechanical bowel preparation: a randomized prospective trial [Ｊ]. Ann Surg, 2003; 237(3): 363-367.
13. Jansen JO, O’Kelly TJ, Krukowski ZH, et al. Right hemicolectomy: mechanical bowel preparation is not required [Ｊ]. J R Coll Surg Edinb, 2002; 47(3): 557-560.
14. Contant CM, Hop WC, van’t Sant HP, et al. Mechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial [Ｊ]. Lancet, 2007; 370(9605): 2112-2117.
15. Itani KM, Kim L. Mechanical bowel preparation or not for elective colorectal surgery [Ｊ]. Surg Infect (Larchmt), 2008; 9(6): 563-565.
16. Guenaga KK, Matos D, Wille-Jrgensen P. Mechanical bowel preparation for elective colorectal surgery [Ｊ]. Cochrane Database Syst Rev, 2009; (1): CD001544.
17. 劉玉國, 欒麗娟. 恒康正清在結(jié)直腸癌術(shù)前腸道準備中的應(yīng)用 [Ｊ]. 腫瘤基礎(chǔ)與臨床, 2006； 19(4): 326-327.
18. 謝松, 孟榮貴. 大腸疾病診治的機械性腸道準備現(xiàn)狀 [Ｊ]. 醫(yī)學(xué)新知雜志, 2001; 11（2）: 86-87.
19. 盧欣, 毛一雷, 桑新亭, 等. 結(jié)直腸手術(shù)前磷酸鈉鹽一日腸道準備法臨床觀察 [Ｊ]. 中華外科雜志, 2006; 44（19）: 1327-1329.
20. 孫敬平, 馬洪升. 應(yīng)激狀態(tài)下腸屏障功能的變化及其機理的研究進展 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2005; 12(3): 314-316.
21. 余利堅, 徐亮, 姚暉, 等. 腸內(nèi)免疫營養(yǎng)和生態(tài)營養(yǎng)對創(chuàng)傷后大鼠腸屏障功能的影響 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(11): 794-798.
22. Griffiths EA, Duffy LC, Schanbacher FL, et al. In vivo ef-fects of bifidobacteria and lactoferrin on gut endotoxin concentration and mucosal immunity in Balb/c mice [Ｊ]. Dig Dis Sci, 2004; 49(4): 579-589.
23. Li LJ, Wu ZW, Xiao DS, et al. Changes of gut flora and endotoxin in rats with D-galactosamine-induced acute liver failure [Ｊ]. World J Gastroenterol, 2004; 10(14): 2087-2090.
24. 吳仲文. 腸道屏障與腸道微生態(tài) [Ｊ]. 中國危重病急救醫(yī)學(xué), 2004; 16(12): 768-770.
25. 吳國豪. 腸道屏障功能 [Ｊ]. 腸外與腸內(nèi)營養(yǎng), 2004; 11(1): 46-49.
26. 王峰, 趙瑛. D-乳酸與腸道屏障功能 [Ｊ]. 臨床和實驗醫(yī)學(xué)雜志, 2006; 5(4): 423-424.
27. 夏陽, 秦環(huán)龍. 益生菌對大腸癌術(shù)后腸屏障功能及全身炎癥反應(yīng)的影響 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(11): 805-810.
  1. 1. Zmora O, Pikarsky AJ, Wexner SD. Bowel preparation for colorectal surgery [Ｊ]. Dis Colon Rectum, 2001; 44（10）: 1537-1549.
  2. 2. Fa-Si-Oen P, Roumen R, Buitenweg J, et al. Mechanical bowel preparation or not? Outcome of a multicenter, randomized trial in elective open colon surgery [Ｊ]. Dis Colon Rectum, 2005; 48（8）: 1509-1516.
  3. 3. 顧晉. 結(jié)直腸腫瘤外科醫(yī)生觀念的轉(zhuǎn)變 [Ｊ]. 中國實用外科雜志, 2005; 25（10）: 585-587.
  4. 4. 毛一雷, 盧欣. 從腸粘膜屏障角度評價結(jié)直腸手術(shù)前腸道準備 [Ｊ]. 中國醫(yī)學(xué)科學(xué)院學(xué)報, 2004; 26(5): 591-594.
  5. 5. 謝松, 孟榮貴, 于恩達， 等. 選擇性結(jié)直腸手術(shù)前三種腸道準備方案的對照研究 [Ｊ]. 中華普通外科雜志， 2002; 17（2）: 69-71.
  6. 6. Smith SM, Eng RH, Campos JM, et al. D-lactic acid measurements in the diagnosis of bacterial infections [Ｊ]. J Clin Microbiol, 1989; 27(3): 385-388.
  7. 7. Bragg LE, Thompson JS, West WW. Intestinal diamine oxidase levels reflect ischemic injury [Ｊ]. J Surg Res, 1991; 50(3): 228-233.
  8. 8. Buttenschoen K, Berger D, Hiki N, et al. Plasma concentrations of endotoxin and antiendotoxin antibodies in patients with multiple injuries: a prospective clinical study [Ｊ]. Eur J Surg, 1996; 162(11): 853-860.
  9. 9. Nichols RL, Smith JW, Garcia RY, et al. Current practices of preoperative bowel preparation among North American colorectal surgeons [Ｊ]. Clin Infect Dis, 1997； 24(4): 609-619.
  10. 10. 謝尚奎, 吳印愛, 劉獻棠, 等. 直腸癌保肛術(shù)中行吻合口上下雙管引流效果的觀察 [Ｊ].中國普外基礎(chǔ)與臨床雜志, 2001; 8(1): 47-48.
  11. 11. Oliveira L, Wexner SD, Daniel N, et al. Mechanical bowel preparation for elective colorectal surgery. A prospective, randomized, surgeon-blinded trial comparing sodium phosphate and polyethylene glycol-based oral lavage solutions [Ｊ]. Dis Colon Rectum, 1997; 40(5): 585-591.
  12. 12. Zmora O, Mahajna A, Bar-Zakai B, et al. Colon and rectal surgery without mechanical bowel preparation: a randomized prospective trial [Ｊ]. Ann Surg, 2003; 237(3): 363-367.
  13. 13. Jansen JO, O’Kelly TJ, Krukowski ZH, et al. Right hemicolectomy: mechanical bowel preparation is not required [Ｊ]. J R Coll Surg Edinb, 2002; 47(3): 557-560.
  14. 14. Contant CM, Hop WC, van’t Sant HP, et al. Mechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial [Ｊ]. Lancet, 2007; 370(9605): 2112-2117.
  15. 15. Itani KM, Kim L. Mechanical bowel preparation or not for elective colorectal surgery [Ｊ]. Surg Infect (Larchmt), 2008; 9(6): 563-565.
  16. 16. Guenaga KK, Matos D, Wille-Jrgensen P. Mechanical bowel preparation for elective colorectal surgery [Ｊ]. Cochrane Database Syst Rev, 2009; (1): CD001544.
  17. 17. 劉玉國, 欒麗娟. 恒康正清在結(jié)直腸癌術(shù)前腸道準備中的應(yīng)用 [Ｊ]. 腫瘤基礎(chǔ)與臨床, 2006； 19(4): 326-327.
  18. 18. 謝松, 孟榮貴. 大腸疾病診治的機械性腸道準備現(xiàn)狀 [Ｊ]. 醫(yī)學(xué)新知雜志, 2001; 11（2）: 86-87.
  19. 19. 盧欣, 毛一雷, 桑新亭, 等. 結(jié)直腸手術(shù)前磷酸鈉鹽一日腸道準備法臨床觀察 [Ｊ]. 中華外科雜志, 2006; 44（19）: 1327-1329.
  20. 20. 孫敬平, 馬洪升. 應(yīng)激狀態(tài)下腸屏障功能的變化及其機理的研究進展 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2005; 12(3): 314-316.
  21. 21. 余利堅, 徐亮, 姚暉, 等. 腸內(nèi)免疫營養(yǎng)和生態(tài)營養(yǎng)對創(chuàng)傷后大鼠腸屏障功能的影響 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(11): 794-798.
  22. 22. Griffiths EA, Duffy LC, Schanbacher FL, et al. In vivo ef-fects of bifidobacteria and lactoferrin on gut endotoxin concentration and mucosal immunity in Balb/c mice [Ｊ]. Dig Dis Sci, 2004; 49(4): 579-589.
  23. 23. Li LJ, Wu ZW, Xiao DS, et al. Changes of gut flora and endotoxin in rats with D-galactosamine-induced acute liver failure [Ｊ]. World J Gastroenterol, 2004; 10(14): 2087-2090.
  24. 24. 吳仲文. 腸道屏障與腸道微生態(tài) [Ｊ]. 中國危重病急救醫(yī)學(xué), 2004; 16(12): 768-770.
  25. 25. 吳國豪. 腸道屏障功能 [Ｊ]. 腸外與腸內(nèi)營養(yǎng), 2004; 11(1): 46-49.
  26. 26. 王峰, 趙瑛. D-乳酸與腸道屏障功能 [Ｊ]. 臨床和實驗醫(yī)學(xué)雜志, 2006; 5(4): 423-424.
  27. 27. 夏陽, 秦環(huán)龍. 益生菌對大腸癌術(shù)后腸屏障功能及全身炎癥反應(yīng)的影響 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(11): 805-810.