大肠癌术前肠道准备临床研究

Clinical meaning of preoperative intestinal preparation in colorectal cancer

目的观察大肠癌术前未口服抗生素行肠道准备的效果。方法随机将温州市肿瘤医院外科2000年8月至2003年8月收治的60例大肠癌病人分为2组。治疗组30例,术前未口服抗生素行肠道准备,其他治疗同传统方式。对照组30例,术前行传统肠道准备。2组手术前、后分别取粪便作肠道菌群分析、血细菌培养,并观察术后并发症。结果治疗组病人术后肠道菌群无明显变化,而对照组病例术后肠道菌群却发生明显变化,具体表现为大肠杆菌、肠球菌计数较治疗组明显增高(P<0.05),而双歧杆菌、乳杆菌、真杆菌计数则明显降低(P<0.05),双歧杆菌/大肠杆菌值倒置比治疗组更为明显(0.03±0.01对0.74±0.15,P<0.01)。所有病例术前血细菌培养均为阴性。治疗组术后血细菌培养阳性率、感染性并发症发生率分别为3.3%、10.0%,对照组分别为20.0%、33.3%,两组之间差异均有显著意义(P<0.05)。结论大肠癌术前肠道准备未口服抗生素可以避免肠道菌群失调、损害肠屏障功能而导致细菌易位,从而降低术后感染性并发症发生率。

Objective To observe the effect of preoperative intestinal preparation disusing oral antibiotic in colorectal cancer. Methods Sixty patients with colorectal cancer admitted between August 2000 and August 2003 were randomly divided into two groups ： the study group were 30 patients without using oral antibiotic during preoperative intestinal preparation. The control group were 30 patients with traditional preoperative intestinal preparation. The perioperative changes of intestinal flora,hemocuhure and postoperative complication were observed in the two groups. Results The postoperative intestinal flora didn＇t change considerably in the study group, but that changed significantly in the control group. Postoperative population of escherichia coli and enterococcus in the control group were much higher than those in the study group （ P 〈0.05）,while bifid bacterium, lactobacillus and eubacterium decreased significantly （ P 〈 0. 05 ）. Postoperative bifidobacterium/E, coli ratio was inverted considerably in the control group more than that in the study group （0. 03 ± 0.01 vs 0. 74 ±0. 15, P 〈0. 01 ）. Preoperative hemocuhure were negative in all patients. Postoperative hemocuhure positive and infection rates were 3.3% and 10. 0% in the study group,20. 0% and 33.3% in the control group. There were all more significant differences between them （ P 〈 0. 05）. Conclusion Preoperative intestinal preparation without using oral antibiotic can avoid alteration of intestinal flora, damage intestinal barrier action and cause bacterial translocation,finally reduce postoperative infection in the patients of colorectal cancer.