基于倾向性评分匹配分析腹腔镜结肠癌根治术后肠道菌群失调的临床特征和危险因素

The manifestations and risk factors of intestinal flora disorder after laparoscopic colon surgery:a single-center retrospective analysis

目的探讨腹腔镜结肠癌根治术后发生肠道菌群失调(IFD)的临床特征和危险因素。方法回顾性分析2019年1月至2023年10月中国医学科学院北京协和医院基本外科诊治的1073例接受腹腔镜结肠癌根治术病人的临床资料。使用倾向性评分进行匹配后根据是否发生IFD,分为菌群失调组(97例)和无菌群失调组(194例)。比较两组病人的临床特征并利用二分类变量条件logistic回归分析IFD的危险因素。结果IFD的临床表现主要为腹泻(50例,51.5%)和腹胀(38例,39.2%),多数病人经过调节菌群和抗感染治疗后获临床痊愈,分别有23例(23.7%)和11例(11.3%)病人行胃管和肠梗阻导管减压引流,置管时机分别以术后第4~6 d(17例,73.9%)和术后第7~12 d(7例,63.6%)较为常见。多因素logistic回归分析发现,术前合并肠梗阻(OR=4.88,95%CI 1.17~20.39,P=0.030)和术后早期使用抗生素(OR=7.94,95%CI 2.19~28.74,P=0.002)是IFD的独立危险因素,术前肠道准备的同时辅以肠外营养支持治疗(OR=0.06,95%CI 0.02~0.19,P<0.001)是IFD的保护因素。结论IFD以腹泻或腹胀为常见首发临床表现,多数可经保守治疗后痊愈。对于合并术前肠梗阻或术后早期应用抗生素者,需警惕IFD的发生,术前肠外营养治疗可能会降低IFD的发生风险。

Objective To investigate the clinical characteristics and risk factors of intestinal flora disorder(IFD)after laparoscopic radical coloectomy.Methods A retrospective analysis was conducted on clinical data from 1073 patients who underwent laparoscopic radical coloectomy in the Department of General Surgery,Peking Union Medical College Hospital,from January 2019 to October 2023.Patients were categorized into the IFD group(n=97)and the non-IFD group(n=194)based on the occurrence of IFD,after propensity score matching.The clinical characteristics of patients in the two groups were compared,and conditional logistic regression analysis of binary variables was applied to identify the risk factors of IFD.Results The most common manifestations of IFD were diarrhea(50 patients,51.5%)and abdominal distension(38 patients,39.2%).Most patients achieved clinical recovery after adjusting the intestinal flora and receiving anti-infective treatment,with 23 patients(23.7%)and 11 patients(11.3%)requiring gastric tube and intestinal obstruction tube decompression,respectively.The most common timing for tube placement was postoperative days 4-6(73.9%)and postoperative days 7-12(63.6%).Multivariate logistic regression analysis revealed that preoperative intestinal obstruction(OR=4.88,95%CI 1.17-20.39,P=0.030)and early postoperative antibiotic(OR=7.94,95%CI 2.19-28.74,P=0.002)were independent risk factors for IFD,while enteral nutrition support before surgery(OR=0.06,95%CI 0.02-0.19,P<0.001)was a protective factor of IFD.Conclusion The most common manifestations of IFD were diarrhea and abdominal distension,most patients could be managed conservatively.For patients with preoperative intestinal obstruction or early postoperative antibiotics,attention should be paid to IFD.Simultaneous enteral nutrition prior to surgery may reduce the risk of IFD.