免疫微生态营养替代传统肠道准备在微创治疗结直肠癌中的应用

Use of immune microecological nutrition as an alternative to traditional bowel preparation in minimally invasive treatment of colorectal cancer

目的:观察免疫微生态营养作为肠道准备方法的有效性及患者术后炎症反应及免疫状态.方法:将60例行择期腹腔镜结直肠癌根治性手术的患者随机分为试验组30例和对照组30例.对照组采用传统的3d肠道准备方法,试验组在术前3d给予患者免疫微生态营养.术前1d晚间给予患者恒康正清(聚乙二醇电解质)按说明书配置3000mL液体导泻.术后接受等氮量等热卡营养支持.术前3d及术后第1次排便检测粪便中肠道菌群,术中观察肠道清洁度,检测术前及术后第5天淋巴细胞计数,免疫球蛋白IgG、IgA、IgM,血清补体C3、C4及血清C反应蛋白浓度;观察术后白细胞计数恢复正常时间、排气时间及吻合口瘘等发生情况.结果:经过统计学计算,试验组和对照组清肠效果的优、良率分别为90%和93.3%,无显著性差异.术前肠道菌群比例,淋巴细胞计数,血清免疫球蛋白,血清补体及血清C反应蛋白浓度等指标均无显著性差异.术后第5天淋巴细胞计数试验组(1.40±0.44)高于对照组(1.15±0.40).免疫球蛋白试验组IgG(9.32±2.11)、IgA(1.95±0.31)、IgM(1.45±0.45)明显高于对照组IgG(8.10±2.34)、IgA(1.78±0.27)、IgM(1.22±0.51),血清补体试验组C3(1.62±0.27)和C4(0.87±0.11)明显高于对照组C3(1.45±0.24)和C4(0.71±0.12),以上数据差异均有统计学意义(P<0.05).血清C反应蛋白浓度术后试验组(16.0±2.3)明显低于对照组(18.2±2.9),差异有统计学意义(P<0.05).术后患者白细胞计数恢复正常时间及排气时间较对照组明显提前,感染发生例数试验组少于对照组(P<0.05).吻合口瘘情况试验组与对照组无统计学差异.结论:免疫微生态营养作为肠道准备方法有效可行.益于术后重建肠道菌群,且有利于结直肠癌术后肠道功能的保护及恢复,减少术后早期炎性反应,改善患者免疫功能.

AIM： To observe the effect of immune micro-ecological nutrition as a bowel preparation method on postoperative inflammatory reaction and immune condition in patients with colorectal cancer after laparoscopic radical resection. METHODS： Sixty patients with colorectal cancer were randomly divided into either a trial group or a control group. Three-day conventional bowel preparation was administered in the control group, while immune micro-ecological nutrition was administered in the trial group. Quality of the preparation was estimated during operation. Intestinal flora in the stool, lymphocyte count, immune globulins, and serum C-reactive protein were measured before and 5 d after the operation. Meanwhile, the time required for intestinal function recovery and incidence of postoperative complications were recorded. RESULTS： Good and excellent bowel preparation was achieved in 90% of patients in the trial group and in 93% of patients in the control group. There was no significant difference between the trial and control groups in the bowel clear effect. Preoperative intestinal flora, lymphocyte count, serum immunoglobulin and complement in blood showed no significant differences between the two groups. Postoperative lymphocyte count （1.40 ± 0.44 vs 1.15 ± 0.40, P 0.05）, immune globulins IgG （9.32 ± 2.11 vs 8.10 ± 2.34, P 0.05）, IgA （1.95 ± 0.31 vs 1.78 ± 0.27, P 0.05）, IgM （1.45 ± 0.45 vs 1.22 ± 0.51, P 0.05）, serum C3 （1.62 ± 0.27 vs 1.45 ± 0.24, P 0.05） and C4 （0.87 ± 0.11 vs 0.71 ± 0.12, P 0.05） were significantly higher in the trial group than in the control group, while postoperative serum C-reactive protein was significantly lower in the trail group than in the control group （16.0 ± 2.3 vs 18.2 ± 2.9, P 0.05）. The time required for intestinal function recovery was significantly shorter in the trial group than in the control group. The incidence of anastomotic fistula showed no statistical difference between the two groups. CONCLUSION： Immune micro-ecological nutrition as a bowel preparation method is effective and feasible in reconstructing postoperative intestinal flora, recovering postoperative intestinal function, diminishing early postoperative inflammatory reaction and building up patients＇ immune function.