远端胃癌根治术患者不同消化道重建肠道微生态的差异性及双歧杆菌的干预效果

Differences in intestinal microecology among patients with distal gastrectomy and different digestive tract reconstruction operations and intervention effects of Bifidobacterium

目的探讨远端胃癌根治术患者不同消化道重建肠道微生态的差异性及双歧杆菌的干预效果。方法回顾性分析2017年3月-2019年3月125例于我院行胃癌根治术后消化道重建手术患者的临床资料,行空肠间置吻合术42例作为A组(其中26例给予双歧杆菌干预),行食管残胃后壁吻合术43例作为B组(其中25例给予双歧杆菌干预),行食管空肠Roux-en-Y吻合术40例作为C组(其中23例给予双歧杆菌干预)。获取患者手术情况,定性、定量分析各组肠杆菌、肠球菌、双歧杆菌、乳杆菌、拟杆菌及梭杆菌数量,分析肠道微生态差异性、双歧杆菌干预效果、肠道微生态失衡发生率及远期疗效。结果 C组肛门排气时间、肠鸣音恢复时间短于A、B组(P<0.05),双歧杆菌干预对该指标无影响。组间比较,术后A、B组肠杆菌、肠球菌、拟杆菌及梭杆菌数量高于术前而双歧杆菌、乳杆菌低于术前(P<0.05),术后C组肠杆菌、肠球菌、拟杆菌及梭杆菌数量高于A、B组而双歧杆菌、乳杆菌低于A、B组(P<0.05);组内比较,干预组肠杆菌、肠球菌、拟杆菌及梭杆菌数量低于未干预组而双歧杆菌、乳杆菌高于未干预组(P<0.05)。C组患者胃食管返流征、倾倒综合征发生率低于A、B组(P<0.05)。结论行食管空肠Roux-en-Y吻合术的远端胃癌根治术患者表现出更明显的肠道微生态平衡,可减少并发症发生,促进术后恢复及提高远期疗效。另消化道重建术前应注意益生菌补充,对提高手术效果有重要价值。

Objective To investigate the differences in intestinal microecology among patients with distal gastrectomy and different digestive tract reconstruction and effects of Bifidobacterium intervention. Methods The clinical data of 125 cases of digestive tract reconstruction after radical gastrectomy in our hospital from March 2017 to March 2019 were analyzed retrospectively. Group A(n=42)underwent jejunal interposition anastomosis, group B(n=43) underwent esophagogastric anastomosis, and group C(n=40) underwent Roux-en-Y esophagojejunostomy. Bifidobacterium intervention was given to 26 cases in group A, 25 cases in group B, and 23 cases in group C. The operation related indexes were recorded. The amount of Enterobacteriaceae, Enterococcus, Bifidobacterium, Lactobacillaceae, Bacteroides and Clostridium in each group was analyzed qualitatively and quantitatively. The intestinal microecology difference, Bifidobacterium intervention effect, incidence of intestinal microecology imbalance and long-term effect were analyzed. Results The time to recovery of anal exhaust and bowel sounds in group C was shorter than in group A and B respectively(P<0.05);Bifidobacterium intervention had no effect on the index. The amounts of Enterobacteriaceae, Enterococcus, Bacteroides and Clostridium were higher, and those of Bifidobacterium and Lactobacillaceae were lower in group A and B than those before operation, while those in group C were higher and lower than in group A and B, respectively(P<0.05). The amounts of Enterobacteriaceae, Enterococcus, Bacteroides and Clostridium in the intervention group were higher, while those of Bifidobacterium and Lactobacillaceae were lower than in the non-intervention group respectively. The incidences of gastroesophageal reflux syndrome and dumping syndrome in group C were lower than in group A and B respectively(P<0.05). Conclusion Patients with Roux-en-Y esophagojejunostomy after radical gastrectomy have better intestinal microecological balance, which can reduce complications, promote postoperative recovery and improve long-term efficacy.In addition, probiotics supplementation before digestive tract reconstruction is of great value in improving the surgical effect.