| Objective:Exploring the effectiveness and safety of using lactulose combined with enteral nutrition for preoperative bowel preparation in elderly patients with poor tolerance of colorectal cancer.Methods:212 elderly patients(aged 65 and above)who underwent elective colorectal cancer surgery and were admitted to the Department of General Surgery at the Affiliated Hospital of YangZhou University between March 2020 and February 2023 were selected.Patients were divided into two groups based on the different bowel preparation methods used before surgery:the polyethylene glycol electrolyte solution group and the lactulose oral solution group.The patients were further divided into four groups based on whether they received preoperative enteral nutrition support:the PEG group(50 patients),PEG plus EN group(52 patients),lactulose group(56 patients),and lactulose plus EN group(54 patients).The four groups were compared in terms of bowel preparation tolerance,cleanliness,surgery-related data,postoperative complication rates,prognosis,and blood biochemical test results.Statistical analysis was performed using SPSS 26.0 to comprehensively compare the safety and effectiveness of the four bowel preparation methods.Results:(1)There was no significant difference(P>0.05)in gender,age,preoperative BMI,presence of underlying diseases,presence of constipation,primary tumor site,and nutritional risk screening score among the four patient groups;there was also no significant difference(P>0.05)in pathological features,including TNM staging,tumor differentiation,and vascular invasion.(2)There was a statistically significant difference(P<0.05)in the tolerability of bowel preparation and the use of enemas among the four patient groups.(3)There was no significant difference(P>0.05)in surgical time,intraoperative bleeding,intestinal cleanliness,and intestinal handling methods among the four patient groups.(4)There was a significant difference(P<0.05)in the incidence of postoperative gastrointestinal reactions(including nausea,vomiting,bloating,and diarrhea)and the time to first flatus among the four groups of patients.There was no significant difference(P>0.05)in the incidence of postoperative fever,incisional infection,extubation time,or length of hospital stay.Seven cases of anastomotic leakage occurred in total,with five cases being grade B and improving after conservative treatment with systemic antibiotics and continuous irrigation of drainage tubes,and two cases being grade C and requiring repeat surgery and intensive care before improving and being discharged.Eighteen cases were simple intra-abdominal infections.There was no statistically significant difference(P>0.05)in the incidence of anastomotic leakage/simple intra-abdominal infection between the four groups.(5)There was no significant difference(P>0.05)in the incidence of electrolyte disturbances before and after surgery among the four patient groups.The mean hemoglobin levels before and after surgery and the mean albumin levels before and after surgery were also comparable among the four groups(P>0.05).The mean levels of prealbumin before and after surgery on day 6 were not significantly different among the four groups(P>0.05),but there were significant differences in the mean prealbumin levels on postoperative day 1 and 3(P<0.05).Based on the mean prealbumin levels on postoperative day 1 and 3,there were no significant differences in pairwise comparisons within the non-EN groups(A1,B1)and within the EN groups(A2,B2)(P>0.05),while there were significant differences in the mean prealbumin levels between the non-EN groups(A1,B1)and the EN groups(A2,B2)on postoperative day 1 and 3(P<0.05).There was no significant difference(P>0.05)in the mean white blood cell count before and after surgery and in the neutrophil-to-lymphocyte ratio before and after surgery.Conclusion:(1)For elderly patients with poor tolerance and poor baseline conditions with colorectal cancer,oral lactulose as bowel preparation is safe and effective,and has clinical practical value.(2)Patients who take lactulose oral solution have fewer adverse reactions and better tolerance.(3)The combination of lactulose and enteral nutrition can effectively improve the postoperative nutritional status of elderly patients,enhance perioperative tolerance,and accelerate the recovery of postoperative gastrointestinal function.However,there is still insufficient evidence regarding whether it can reduce the incidence of anastomotic leakage. |
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