摘要
目的:探究益生菌对胃肠癌术后肠梗阻的预防作用并分析其对肠道菌群多样性的影响.方法:前瞻性选取山西省肿瘤医院胃肠外科2021年1月-2022年1月收治的133例行胃肠癌手术的患者作为研究对象,采用简单随机分组中掷硬币法分为A、B两组,最终纳入A组74例、B组59例.A组术后行常规治疗管理并口服益生菌制剂,B组仅行常规治疗管理.比较两组胃肠道功能恢复指标,观察两组术前、术后7 d主要肠道菌群计数,菌群混乱分度,肠道屏障功能指标二胺氧化酶(DAO)、D-乳酸、组氨酸脱羧酶(HDC)的变化,对比两组肠梗阻等并发症发生情况.结果:(1)A组首次通气时间、首次排便时间、恢复经口饮食时间、住院时间均显著低于B组(P＜0.05);(2)术后7 d,A组肠球菌、大肠杆菌计数显著低于B组,而双歧杆菌、乳酸杆菌计数高于B组(P＜0.05);(3)术后7 d两组菌群混乱分度情况差异有统计学意义(P＜0.05);(4)术后7 d,两组DAO、D-乳酸、HDC水平均上升且A组低于B组(P＜0.05);(5)A组并发症总发生率显著低于B组(4.05％比15.25％,P＜0.05).结论:胃肠癌术后口服益生菌能够明显改善患者肠道微生态环境、调节菌群计数、促进胃肠道黏膜屏障保护功能,有效降低肠梗阻等并发症发生率,具有重要的临床应用价值.
Abstract
Objective:To explore the preventive effect of probiotics on postoperative intesti-nal obstruction in patients after gastrointestinal cancer surgery and to analyze their impact on the diversity of the gut microbiota.Methods:A prospective study was conducted involving 133 pa-tients who underwent gastrointestinal cancer surgery at the Shanxi Cancer Hospital's Department of Hepatobiliary pancereatogastric surgery from January 2021 to January 2022.Patients were ran-domly divided into two groups,Group A and Group B,using a simple randomization method based on coin toss,with Group A consisting of 74 cases and Group B of 59 cases.Group A received rou-tine postoperative management along with oral probiotic formulations,while Group B received only routine management.The study compared gastrointestinal functional recovery indicators,observed the counts of major gut microbiota before and 7 days after surgery,the degree of microbiota dys-biosis,and intestinal barrier function indicators such as diamine oxidase(DAO),D-lactic acid,and histidine decarboxylase(HDC)between the two groups,and compared the incidence of complica-tions such as intestinal obstruction.Result:(1)The time to first flatus,first bowel movement,re-sumption of oral intake,and hospital stay in Group A were significantly shorter than in Group B(P＜0.05);(2)Seven days postoperatively,the counts of Enterococcus and Escherichia coli in Group A were significantly lower than in Group B,while the counts of Bifidobacterium and Lactobacillus were higher in Group A(P＜0.05);(3)The degree of microbiota dysbiosis 7 days postoperatively was statistically significantly different between the two groups(P＜0.05);(4)Seven days postoperatively,the levels of DAO,D-lactic acid,and HDC increased in both groups,with Group A having lower lev-els than Group B(P＜0.05);(5)The overall incidence of complications in Group A was significantly lower than in Group B(4.05％vs 15.25％,P＜0.05).Conclusion:Oral administration of probiotics after gastrointestinal cancer surgery can significantly improve the intestinal microecological environ-ment,regulate the counts of gut microbiota,promote the protective function of the gastrointestinal mucosal barrier,effectively reduce the incidence of complications such as intestinal obstruction,and has significant clinical application value.
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