PEC途径行粪菌移植加肠内营养治疗复发性溃疡性结肠炎  

Enteral nutrition fecal microbiota transplantation via percutaneous endoscopic cecostomy in treatment of recurrent ulcerative colitis

作　　者：倪小冬[1] 李幼生[1] 张永良[1] 陶申 汪志明[1] 黎介寿[1] 

机构地区：[1]南京军区南京总医院解放军普通外科研究所,江苏南京210002

出　　处：《肠外与肠内营养》2015年第1期29-33,38,共6页Parenteral & Enteral Nutrition

摘　　要：目的:探讨通过经皮内镜下盲肠造口置管术(PEC)途径行粪菌移植治疗溃疡性结肠炎(UC)的可行性及实施流程。方法:男性病人,24岁,因间断腹痛伴黏液血便6年以UC治疗无效收住入院。入院后经PEC行粪菌移植,观察病人症状、体征、粪便性状及习惯变化、肠内营养(EN)耐受情况以及结肠镜下表现的变化。结果:住院期间每天1次粪菌移植,连续行30次。出院后按医院内同样的程序每天1次连续行10次粪菌移植。住院期间,粪菌移植治疗后排便次数及粪便性状逐渐正常;粪菌移植1周后已恢复全EN,1个月后开始过渡至口服饮食,内镜下可见明显好转。出院后病人逐渐恢复完全口服饮食,排便正常,1次/d。粪菌移植结束后2个月复查结肠镜未见明显病变,予以拔除PEC。随访3个月,病人日常口服饮食,排成形粪便每天1次,无腹痛、腹泻或便血等症状。结论:经PEC置管后行粪菌移植病人能耐受长时间的治疗,特别是可在家庭中安全实施,初步治疗及短期随访也证实其安全性和有效性。Objective： To practise fecal microbiota transplantation to treat ulcerative colitis via percutaneous endoscopic cecostomy pathway and to investigate the procedures. Methods： A 24-yearold man with a history of recurrent ulcerative colitis was admitted to our hospital and received PEC to provide drug enema. Then fecal microbiota transplantation via PEC pathway was performed. Clinical symptom,the frequency and characteristics of stools,the change of nutrition therapy and the findings were observed. Results： The patient received FMT daily for 30 days in hospital and 10 days at home. there was no discomfort during the process. The frequency and characteristics of stools were improved. Enteral nutrition regained after 1 week and oral diet began 1 month later. After two months of FMT end point,the patient had already resumed normal diet with formed soft stool once a day. The follow-up colonoscope showed normal mucous membrane in the colon then the PEC has been removed. During the 3 months follow-up by telephone and internet,nothing was found abnormal. Conclusion： The preliminary result of fecal microbiota transplantation to treat ulcerative colitis via percutaneous endoscopic cecostomy pathway was satisfactory. This procedure can be performed continuously for a long time and especially to practise at home.

关 键 词：溃疡性结肠炎 经皮内镜下盲肠造口置管术 粪菌移植 

分 类 号：R574.62[医药卫生—消化系统]