益生菌制剂防治胃溃疡Billroth-Ⅰ术后并发症及改善胃肠道功能的研究

Effect of probiotics on prevention and treatment of Billroth-Ⅰpostoperative complications of gastric ulcer and improvement of gastrointestinal function

目的:探究围术期使用益生菌制剂对降低胃溃疡Billroth-Ⅰ术后并发症及改善胃肠道功能的影响,为临床治疗提供参考。方法:选择因胃溃疡行Billroth-Ⅰ手术治疗的72例患者进行前瞻性研究,患者被随机分为对照组和观察组,并在围术期进行益生菌制剂干预治疗。收集患者的一般信息、术后血常规及感染指标、术后早期并发症及远期并发症等资料,在术前、术后1个月和术后1年分别进行胃肠道症状评定量表(gastrointestinal symptom rating scale,GSRS)评价。随访1年后对两组患者的一般资料、术后早期并发症和术后晚期并发症进行组间分析,对两组患者术前、术后1个月和术后1年的GSRS评分进行组间和组内分析,明确围术期使用益生菌制剂对患者术后并发症和胃肠道功能的影响。结果:与对照组比较,观察组患者在术后1 d和术后5 d时各项感染指标均显著降低(P<0.05);在术后早期并发症方面,与对照组比较,观察组在术后3 d腹腔引流量、拔管时间、首次排气时间、住院时间、感染相关并发症方面均显著降低(P<0.05);在吻合口瘘发生率方面两组差异无统计学意义(P>0.05),但观察组发生吻合口瘘的例数较对照组更少;在术后远期并发症方面,观察组患者的营养障碍、胃排空障碍、倾倒综合征和胃溃疡复发的发生率与对照组比较差异无统计学意义(P>0.05)。两组患者术后1个月和术后1年GSRS评分均显著低于术前,且术后1个月评分显著低于术后1年(P<0.001);与对照组比较,观察组术后1个月GSRS评分显著降低,差异有统计学意义(P<0.001),但两组患者术前和术后1年GSRS评分比较差异无统计学意义(P>0.05)。结论:因胃溃疡行Billroth-Ⅰ手术治疗的患者,在围术期使用益生菌制剂可以降低术后早期并发症的发生率,加快胃肠道功能恢复,缩短住院时间,改善生活质量。

Objective:To explore the effect of perioperative use of probiotics on reducing complications and improving gastrointestinal function after Billroth-Ⅰgastric ulcer surgery,the prospective study was performed and provided the reference for clinical treatment.Methods:Seventy-two patients with gastric ulcer treated by Billroth-Ⅰsurgery were selected for prospective study.The patients were randomly divided into the control group and the observation group,and were treated with probiotics during the perioperative period.The patients'general information,early postoperative complications and late postoperative complications were collected,and the gastrointestinal symptom rating scale(GSRS)was obtained before the surgery,one month and one year after surgery.The general data,postoperative blood counts and infection indicators,early postoperative complications and late postoperative complications were compared between the two groups.The scores of gastrointestinal symptoms before operation,one month and one year after operation were compared between and within two groups.Finally,the effect of perioperative use of probiotics on postoperative complications and gastrointestinal function was investigated.Results:Compared with the control group,patients in the observation group showed a significant reduction in blood infection indicators at one day and five days postoperatively(P<0.05).In terms of early postoperative complications,compared with the control group,the observation group had significantly lower abdominal drainage volume at three days after operation,extubation time,first exhaust time,hospitalization time,and infection rate(P<0.05).There was no significant difference in the incidence of anastomotic leakage between the two groups(P>0.05),however the incidence of anastomotic leakage in the observation group was less than that in the control group.In terms of long-term postoperative complications,there was no significant difference in the incidence of nutritional disorders,delayed gastric emptying,dumping syndrome and recurrence of gastric ulcer between the two groups(P>0.05).The comparison of GSRS scores within the group showed that the GSRS scores of the two groups at one month and one year after operation were significantly lower than those before operation,and the scores at one month after operation were significantly lower than those at one year after operation(P<0.001).Comparison of GSRS scores between groups showed that compared with the control group,the GSRS score of the observation group decreased significantly at one month after operation,the difference was statistically significant(P<0.001),however there was no significant difference between the two groups before operation and one year after operation(P>0.05).Conclusion:For patients undergoing Billroth-Ⅰsurgery for gastric ulcer,the use of probiotics during the perioperative period can reduce early postoperative complications,accelerate the recovery of gastrointestinal function,shorten the length of hospital stay,and improve the patients'life quality.