不同术后处理因素对结直肠癌病人肠道菌群及近期临床结局影响

EFFECTS OF DIFFERENT POSTOPERATIVE MANAGEMENT ON ENTEROBACTERIA AND SHORT-TERM PROGNOSIS IN PATIENTS WITH COLORECTAL CANCER

目的探讨术后早期进食及应用抗生素对结直肠癌病人肠道菌群及近期临床结局影响。方法结直肠癌病人45例,随机分为术后早期进食+预防性抗生素应用组(Ⅰ组)、术后禁饮食+预防性抗生素应用组(Ⅱ组)及术后早期进食+抗生素无限制应用组(Ⅲ组),细菌培养法比较各组术后粪便肠道菌群情况,观察病人短期临床结局,包括术后排气时间、吻合口漏及切口感染情况。结果术后Ⅱ、Ⅲ组病人大肠杆菌和肠球菌计数与Ⅰ组相比明显增加(F=50.260、55.158,P<0.05),双歧杆菌和乳杆菌计数明显减少(F=24.022、27.027,P<0.05)。Ⅰ组病人排气时间早于Ⅱ、Ⅲ组病人(F=85.830,P<0.05)。结论手术、抗生素应用及术后禁饮食影响围手术期肠道微生态,容易造成肠道菌群失调,影响近期临床结局;而合理应用抗生素、术后早期进食可改善肠道微生态及近期临床结局。

Objective To investigate the influence of early postoperative feeding and use of antibiotic on intestinal flora and short-term clinical outcome in patients with colorectal cancer （CRC）. Methods Forty-five CRC patients were randomized to three groups as groupl-early postoperative feeding plus prophylactic antibiotic; group 2-nothing by mouth after surgery plus pro phylactic antibiotic; group 3 early postoperative feeding plus non-restrictive antibiotic. Postoperative stool was collected and cul tared for comparison of intestinal flora and short term outcomes-such as exhaust time, anastomotic leakage and wound infection between the three groups. Results Compared with group 1, the numbers of E. coli and enterocoecus in groups 2 and 3 markedly increased （F = 50.260,55.158 ;P 〈0.05）, and bifidobaeterium and lactobacillus decreased （ F = 24.022,27. 027 ; P 〈 0.05 ）. The exhaust time in group 1 was earlier than that in groups 2 and 3 （F=85.830,P〈0.05）. Conclusion Surgery, posoperative antibi otic and nothing by mouth affect perioperative intestinal microecology, which lead to alteration of intestinal flora and influence clinical outcomes. A reasonable application of antibiotic and early postoperative feeding can improve microecology of intestinal flora and the outcomes.