摘要
目的探讨围手术期不同处理因素对直肠癌患者术后肠道菌群变化的影响。方法前瞻性入组2010年7月至2011年6月间青岛大学医学院附属医院收治的64例直肠癌患者。按术前肠道准备、抗生素应用和术后禁食3个因素进行析因设计．采用随机数字表法将64例人组患者分为8组．每组8例。收集手术前后粪便标本，倍比稀释后分别涂在选择性培养基上恒温培育48h，对肠道细菌进行计数．比较各组患者手术前后菌群变化的程度。结果与术前相比．各组患者术后肠道菌群发生明显变化，表现为细菌总数、双歧杆菌、消化链球菌、乳酸杆菌、类杆菌和肠球菌明显减少，而大肠杆菌计数明显增加（P〈O．05）；且杆菌与球菌的比例（杆球比）显著紊乱。各组术后细菌总数经过析因设计方差分析显示．肠道准备、抗生素应用及术后禁食均为影响肠道菌群的主要因素（均P〈0．05）。与上述3项因素均限制组相比，抗生素未限制组术后大肠杆菌、类杆菌、肠球菌、乳酸杆菌、消化链球菌及细菌总数均下降，杆球比升高（P〈0．05）；肠道准备组术后类杆菌、消化链球菌、细菌总数及杆球比均下降（P〈0．05）；术后禁食组术后类杆菌、肠球菌、双歧杆菌、细菌总数及杆球比均下降（P〈0．05）。结论抗生素、肠道准备及术后禁饮食均可影响直肠癌患者围手术期肠道菌群在数量及比例的改变．从而导致肠道菌群失调。
Objective To investigate the effects of the different treatment on gut flora in patients with rectal cancer in the perioperative period. Methods A total of 64 patients with rectal cancer were prospectively enrolled from July 2010 to June 2011 at the Qingdao University Medical College Affiliated Hospital, and randomized into 8 groups receiving different treatments in perioperative period. Factorial design was used to study three factors including preoperative bowel preparation, antibiotics use, and postoperative fasting. Patients were randomized into 8 groups with 8 patients in each group using the random digit table. Preoperative and postoperative stool specimens were collected and diluted, which were transferred to selective medium. Bacteria counts were calculated after 48 hours of culture under constant temperature. The changes in gut flora between the different groups were compared. Results Compared to the preoperative parameters, total bacteria, Bzifidobacterium, Peptostreptococcus, Lactobacillus, Bacteroides, Enterococcus decreased significantly （P〈0.05）, while the E.coli count increased significantly. The bacillus/coccus ratio was significantly imbalanced. Preoperative bowel preparation, oral antibiotics, and postoperative fasting were all predominant factors associated with gut flora （all P〈0.05）. Compared with the antibiotic restriction group, Bacteroides, Enterococcus, Lactobacillus, Peptostreptococcus, and total bacteria count were reduced significantly, and the bacillus/coccus ratio increased in the non-antibiotics restriction group （P〈0.05）. In the bowel preparation group, Bacteroides, Peptostreptococcus, total bacteria count, and the bacillus/coccus ratio decreased （P〈0.05）. In the postoperative fasting group, Bacteroides, Enterococcus, total bacteria, and bacillus/coccus ratio decreased （P〈O.05）. Conclusions Antibiotics, bowel preparation, and postoperative fasting can affect the number and ratio of gut flora in patients with rectal cancer in the perioperative period, leading to dysbacteriosis.
出处
《中华胃肠外科杂志》
CAS
2012年第6期570-573,共4页
Chinese Journal of Gastrointestinal Surgery
关键词
肠道菌群
菌群失调
抗生素
肠道准备
禁食
Gut flora
Dysbacteriosis
Antibiotics
Bowel enema
Prohibiting diet
