目的 探讨盆腔器官脱垂手术前常规进行肠道准备与无肠道准备对手术视野及患者的影响,优化肠道准备.方法 本研究为前瞻性随机单盲对照研究.选取2017年9月至2018年7月于北京大学人民医院接受盆腔器官脱垂手术的患者,除外既往结直肠手术史及慢性便秘者.手术医师对患者是否行肠道准备为盲.无肠道准备组术前无肠道准备,肠道准备组术前口服聚乙二醇.主要观察指标是术者在手术中评估是否有粪便泄露以及对手术视野的影响,粪便泄露的性状和体积;术中粪便污染的标准为:轻度,<15 ml,中度,15～30 ml,重度,>30 ml.次要观察指标是患者的满意度及常规肠道准备的不良症状.结果 共计纳入120例患者(无肠道准备组60例、肠道准备组60例),其手术方式包括经阴道子宫切除术、阴道前后壁修补术、骶棘韧带悬吊术、阴道全封闭术、腹腔镜阴道骶骨固定术、抗尿失禁手术等.无肠道准备组患者的中位年龄为62岁,肠道准备组为60岁;两组患者的中位年龄、麻醉方式、手术方式、术中出血量、手术时间、手术部位感染情况比较均无明显差异(P均>0.05).无肠道准备组术中粪便污染的发生率为10％(6/60),肠道准备组为32％(19/60),两组比较,差异有统计学意义(P=0.042);肠道准备组中重度粪便污染的发生率为10％(6/60),而无肠道准备组仅为2％(1/60),两组比较,差异有统计学意义(P=0.017).肠道准备组中,患者出现了恶心(8％,5/60)、呕吐(5％,3/60)、腹胀(22％,13/60)、乏力(5％,3/60)、心慌(2％,1/60)等不良反应,而无肠道准备组均未出现相应症状.结论 盆腔器官脱垂手术前口服泻药的常规肠道准备对手术视野的清洁与无肠道准备相比并无益处,并增加患者肠道准备的不适.多数盆腔器官脱垂的患者不行肠道准备实施盆腔器官脱垂手术是安全可行的.%Objective To investigate the influence of conventional preoperative intestinal preparation and unplanned preparation on the visual field of pelvic organ prolapse repair surgery. Methods The patients who underwent transvaginal pelvic organ prolapse repair surgery in Peking University People′s Hospital from September 2017 to July 2018 were selected as the research objects except those who had undergone colorectal surgery and chronic constipation. The surgery doctor was blinded by intestinal preparation. There was no intestinal preparation in non intestinal preparation group and polyethylene glycol was taken orally in intestinal preparation group. The main outcome measures were the effect of intestinal contents on the surgical field, the presence of fecal leakage, and the nature and volume of fecal leakage. The standard of fecal contamination was: mild, less than 15 ml, moderate, 15-30 ml, and severe,>30 ml. Secondary indicators were patient satisfaction and symptoms of routine bowel preparation. Results A total of 120 patients (60 cases of non intestinal preparation group, 60 cases of intestinal preparation group) were selected, including transvaginal hysterectomy, vaginal anterior or posterior colporrhaphy (some patients with anterior prolapse repair with mesh), sacrospinal ligament suspension, total colpectomy and colpocleisis, laparoscopic sacral colpopexy, anti-incontinence surgery. The median age of the patients in non intestinal preparation group was 62 years, and the median age of intestinal preparation group was 60 years. There were no significant differences in median age, anesthesia, operation method, blood loss, operation time and perioperative infection between the two groups (all P>0.05). Fecal contamination occurred in 10％(6/60) of the patients without intestinal preparation and 32％ (19/60) of the patients with intestinal preparation (P=0.042). Comparing the two groups, 10％(6/60) of the patients with intestinal preparation had moderate and severe contamination, and the patients without intestinal preparation was only 2％ (1/60), there was significant difference (P=0.017). In intestinal preparation group, nausea (8％, 5/60), vomiting (5％, 3/60), abdominal distension (22％, 13/60), fatigue (5％, 3/60) and palpitation (2％, 1/60) were higher than those in non intestinal preparation group. Conclusions Intestinal preparation with oral laxatives before pelvic organ prolapse repair surgery is not beneficial to the cleaning of the surgical field and increases the discomfort of intestinal preparation. It is safe and feasible for most patients with pelvic organ prolapse to perform pelvic organ prolapse repair surgery without intestinal preparation.
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