两种手术方式对结肠癌术后感染及肠道菌群的影响  

Influence of two types of surgeries on postoperative infection and intestinal flora in patients with colon cancer

作　　者：张尚武[1] 郭兴坡[2] 宋世铎[2] 王斌[2] 蒋林华[2] 朱新国[2] 高凌[2] ZHANG Shang-wu;GUO Xing-po;SONG Shi-duo;WANG Bin;JIANG Lin-hua;ZHU Xin-guo;GAO Ling(The First Affiliated Hospital of Soochow University,Suzhou,Jiangsu 215006,China)

机构地区：[1]苏州大学附属第一医院急诊外科,江苏苏州215006 [2]苏州大学附属第一医院普外科,江苏苏州215006

出　　处：《中华医院感染学杂志》2019年第14期2176-2180,共5页Chinese Journal of Nosocomiology

基　　金：江苏省自然科学基金资助项目(BK20161225)

摘　　要：目的比较腹腔镜手术与开腹结肠癌根治术对结肠癌患者感染率及肠道菌群的影响。方法回顾性分析2017年7月-2018年6月医院收治的90例结肠癌患者的病例资料,按照治疗方法分为腹腔镜手术组48例和开腹手术组42例。比较两组术后感染率;患者术前、术后5 d粪便菌群数量;术前、术后1 d、3 d、5 d血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)水平。结果腹腔镜手术组术后感染率为4.16%,低于开腹手术组的16.66%(P<0.05)。两组患者术后1 d、术后3 d、术后5 d血清IL-6、TNF-α、CRP水平较术前升高(P<0.05),腹腔镜手术组患者血清IL-6、TNF-α、CRP水平低于开腹手术组患者(P<0.05)。术后5 d腹腔镜手术组肠道大肠埃希菌、肠球菌低于开腹手术组,乳酸杆菌、双歧杆菌属、双歧杆菌/大肠埃希菌高于开腹手术组(P<0.05)。结论相对开腹结肠癌根治手术,腹腔镜结肠癌根治手术患者术后炎症反应较轻,对肠道菌群影响较小,术后感染发生率也较低。OBJECTIVE To observe and compare the influence of laparoscopic surgery and open radical colon cancer surgery on infection rate and intestinal flora in patients with colon cancer. METHODS A total of 90 patients with colon cancer who were treated in the hospital from Jul 20147 to Jun 2018 were enrolled in the study and divided into the laparoscopic surgery group with 48 cases and the open surgery group with 42 cases according to the treatment mode, and the clinical data of the patients were retrospectively analyzed. The incidence of postoperative infection was compared between the two groups;the bacteria colony counts of stool specimens were recorded before the surgery and after the surgery for 5 days, and the levels of serum interleukin-6(IL-6), tumor necrosis factor-α(TNF-α) and C-reactive protein(CRP) were observed before the surgery and after the surgery for 1, 3 and 5 days. RESULTS The incidence rate of postoperative infection of the laparoscopic surgery group was 4.16%, significantly lower than 16.66% of the open surgery group(P<0.05). The levels of serum IL-6, TNF-α and CRP were significantly higher after the surgery for 1, 3 and 5 days than before the surgery(P<0.05). The levels of serum IL-6, TNF-α and CRP of the laparoscopic surgery were remarkably lower than those of the open surgery group(P<0.05). The colony counts of enteric Escherichia coli and Enterococcus were less in the laparoscopic surgery group than in the open surgery group after the surgery for 5 days, while the colony counts of Lactobacillus, Bifidobacterium, Bifidobacterium/Escherichia coli were greater in the laparoscopic surgery group than in the open surgery group(P<0.05). CONCLUSION As compared with the open radical colon cancer surgery, the laparoscopic surgery may results in less postoperative inflammatory reactions and has less impact on the intestinal flora, with the incidence of postoperative infection lower.

关 键 词：腹腔镜手术 开腹结肠癌根治术 结肠癌 感染率 炎症因子 肠道菌群 

分 类 号：R735.3[医药卫生—肿瘤]