粪菌移植治疗直肠癌根治术后肠道功能紊乱43例疗效观察

Fecal Microbiota Transplantation in the Treatment of Enteric Parafunction of the Patients Underwent Radical Surgery for Rectal Cancer:Effect Observation on 43 Cases

目的:观察粪菌移植(FMT)治疗直肠癌根治术后患者肠道功能紊乱的临床疗效。方法:回顾性分析43例直肠癌根治术后肠道功能紊乱患者的临床资料。分为轻度低位前切除综合征(LARS)组15例,重度LARS组28例,取健康供体新鲜粪便与无菌生理盐水稀释液保留灌肠,1次/d,连续灌肠6d。1个月后再次重复6d粪菌移植。采用LARS量表评估治疗效果。结果:43例中41例完成FMT,2例重度LARS患者中途退出。治疗后4周、8周、12周和24周,轻度LARS患者在气体失禁、便频、密集排便和急迫排便评分方面均明显改善(P<0.05),在稀便失禁方面症状改善不明显(P>0.05)。治疗4周后,26例重度LARS患者总体症状改善不明显(P>0.05),在随后的随访中症状明显改善,评分差异显著(P<0.05)。治疗和随访期间未发生严重不良反应,其中16例患者在研究结束后要求继续使用FMT治疗。结论:FMT治疗直肠癌根治术后肠道功能紊乱临床效果显著,且安全性高。

Objective To observe the clinical effect of fecal microbiota transplantation(FMT)in the treatment of enteric parafunction(disorder)of the patients underwent radical surgery for rectal cancer.Methods Reviewed and analysed the clinical data of 43rectal cancer patients treated with radical surgery and later suffered from enteric disorder in whom 15cases from slight low anterior resection syndrome(LARS),28from severe LARS;then,they all received retention enema(with health donor’s fresh stool plus aseptic normal saline diluted solution);1time/day,for 6days;1 month later to replay FMT for 6days;Finally,by using LARS scale evaluated treatment efficacy.Results In the 43patients,41cases were completed with FMT,but 2cases of severe LARS out of replay FMT.At 4,8,12and 24weeks after treatment slight LARS patients got significantly improved in the score ratings on aero-incontinence,frequent defecation,concentrated defecation and precipitant defecation(P<0.05),but not improved in hydro-stool incontinence(P>0.05);At 4weeks after treatment the whole symptoms of 26patients with severe LARS did not get improved significantly(P>0.05),but along with later follow-up,the symptoms got improved significantly(P<0.05).Amidst treatment and follow-up no severe unward reactions were found,16cases of all want to use FMT therapy coutinuely even at the end of this study.Conclusion FMT therapy for enteric disorders following radical surgery for rectal cancer has great effect,and with high safety.