结肠灌洗对急性结肠梗阻肠道细菌学的影响  

Effects of intraoperative colonic irrigation on bacteriology in treatment for acute colonic obstruction

作　　者：蔡潮农[1] 苏永辉[1] 方瑞君[2] 杨禄坤[3] 

机构地区：[1]中山大学附属第五医院普外科,广东珠海519000 [2]中山大学附属第五医院校区门诊,广东珠海519000 [3]中山大学附属第五医院麻醉科,广东珠海519000

出　　处：《中国现代医学杂志》2015年第18期66-68,共3页China Journal of Modern Medicine

摘　　要：目的研究术中结肠灌洗对急性结肠梗阻患者肠道细菌学的影响,探讨该疾病一期手术吻合的可行性。方法对16例急性结肠梗阻患者术中行结肠灌洗并行一期切除吻合,与16例无结肠梗阻的病例的肠内容物及肠黏膜细菌变化情况进行对比,观察术后两组患者感染发生率。结果梗阻组结肠近端灌洗后肠内容物及肠黏膜细菌数均较灌洗前明显减少,分别为(4.25±1.77)×106cfu/L和(109.0±20.75)×106cfu/L及(20.3±5.31)cfu/cm2和(7 420.6±343.02)cfu/cm2,配对t检验,均是P<0.001;结肠梗阻组近端肠内容物和肠黏膜的细菌数明显高于非梗阻组,肠内容物细菌计数分别为(109.0±20.75)×106cfu/L和(13.6±2.60)×106cfu/L,肠黏膜细菌计数分别为(7 420.6±343.02)cfu/cm2和(332.4±28.47)cfu/cm2,两组数据比较,均是P<0.001;经术中结肠灌洗后,梗阻组近端细菌数却明显较非梗阻下降,肠内容物细菌数分别为(4.25±1.77)×106cfu/L和(13.6±2.60)×106cfu/L,肠黏膜细菌计数分别为(20.3±5.31)cfu/cm2和(332.4±28.47)cfu/cm2,比较后均是P<0.001;而术后梗阻组患者感染发生率与非梗阻组差异无统计学意义(P>0.05)。结论术中结肠灌洗,能使急性结肠梗阻结肠内细菌数明显减少,达到或低于非梗阻组肠道细菌数。【Objective】To study the effects of intraoperative colonic irrigation on bacteriology in treatment for acute colonic obstruction and explore the feasibility of one-stage anastomosis in this disease. 【Methods】Sixteen cases with acute colonic obstruction underwent intraoperative colonic irrigation and then received one-stage resection and anastomosis（obstruction group）. Sixteen cases of colonic tumor without obstruction were used as controls（control group）. The colonic contents and mucosa were collected for bacteria counting before and after irrigation. The incidence of infection was compared between both groups.【Results】 In the obstruction group, the bacterial numbers of colonic content and mucosa after irrigation [（4.25 ± 1.77）×106 cfu/L,（20.3 ± 5.31） cfu/cm2]were significantly smaller than those before irrigation [（109.0 ± 20.75） ×106cfu/L,（7420.6 ± 343.02） cfu/cm2; P 〈0.001]. Before irrigation, the bacterial numbers of colonic content and mucosa in the obstruction group were significantly larger than those [（13.6 ± 2.60）×106 cfu/L and（332.4 ± 28.47） cfu/cm2] in the control group（P 〈 0.001）.But the bacterial numbers of the obstruction group after colonic irrigation were significantly smaller than those of the control group（P 〈 0.001）. There was no significant difference in the postoperative infection rate between both groups（P = 0.484）. 【Conclusions】The colonic bacteria in patients with acute colonic obstruction can be greatly reduced by intraoperative colonic irrigation, which could be at the same level as or even fewer than those in patients without intestinal obstruction.

关 键 词：结肠灌洗 肠梗阻 肠道细菌 

分 类 号：R656.9[医药卫生—外科学]