加速康复外科(ERAS)对腹腔镜胃癌手术患者术后肠功能及肠道菌群变化的影响  

Effect of enhanced recovery after surgery on intestinal function and gut microbiota changes in patients undergoing laparoscopic gastrectomy

作　　者：姚增武 王熙勋[1] 胡金晨 张翼飞[1] 赵大伟[1] 崔伟豪 刘传绪 姜立新[1] Yao Zengwu;Wang Xixun;Hu Jinchen;Zhang Yifei;Zhao Dawei;Cui Weihao;Liu Chuanxu;Jiang Lixin(Gastrointestinal Surgery Ward 1 and Thyroid Surgery Ward,Yantai Yuhuangding Hospital,Yantai 264000,China)

机构地区：[1]烟台毓璜顶医院胃肠外一科甲状腺外科,264000

出　　处：《中华内分泌外科杂志》2021年第6期583-587,共5页Chinese Journal of Endocrine Surgery

基　　金：山东大学项目(3460019005);烟台市科技发展计划(2019MSGY136、2017YD009);烟台毓璜顶医院青年科研启动基金(201813)。

摘　　要：目的研究加速康复外科(enhanced recovery after surgery,ERAS)在腹腔镜胃癌患者术后肠道功能及肠道菌群变化的影响。方法选取2018年8月至2019年12月在烟台毓璜顶医院胃肠外一科、甲状腺外科接受腹腔镜胃癌根治性D2手术的患者80例。根据是否为ERAS处理分为2组(n=40):ERAS组和传统围手术期处理组。记录两组患者的术后肠鸣音出现时间、第1次排气及排便时间,抗生素相关性腹泻(AAD)及手术部位感染(SSI)的比例。收集术前、术后第1次、术后1、2周及1月的粪便,采用16S rRNA测序的方法进行肠道菌群多样性和种类的鉴定,比较围手术期肠道菌群多样性指数及益生菌(双歧杆菌及乳酸杆菌)比例的变化。结果ERAS组肠鸣音出现时间、第1次排气及排便时间[(16.25±6.41)h、(23.95±6.02)h、(34.95±9.34)h]显著小于传统处理组[(22.3±6.49)h、(28.45±7.12)h、(48.1±15.64)h],差异有统计学意义(P<0.05)。抗生素相关性腹泻发生比例在传统处理组(3/40)比ERAS组(1/40)高,但差异无统计学意义(P>0.05)。ERAS组和传统处理组术后手术部位感染(SSI)比例(1/10,3/40),ERAS组略高,但差异无统计学意义(P>0.05)。围手术期肠道菌群多样性指数(Chao1及shannon指数)及益生菌(嗜酸乳杆菌和双歧杆菌)所占比例,术前两组之间无明显差异(P>0.05),术后第1次、第1周、术后2周及术后1个月,ERAS组较传统组均高(P<0.05);在术后各时间点,传统组下降较ERAS组明显,术后第1次降低值最大(P<0.05);术后随着时间的推移,肠道菌群多样性和益生菌比例逐渐回升,至术后1个月,两组均未恢复至术前肠道菌群多样性的状态及比例。结论加速康复外科理念(ERAS)促进了胃癌患者术后肠道早期运动功能的恢复,没有降低抗生素相关性腹泻的发生或增加手术部位感染(SSI)的比例,维持了肠道菌群多样性的平衡和稳定。Objective To study the effect of enhanced recovery after surgery(ERAS)on intestinal function and gut microbiota changes in patients who underwent laparoscopic gastrectomy.Methods From Aug.2018 to Dec.2019,80 patients who underwent laparoscopic radical D2 gastrectomy for gastric cancer in the first Department of Gastrointestinal Surgery of Yantai Yuhuangding Hospital were selected.According to whether it adopts ERAS treatment or not,patients were divided into 2 groups(n=40):ERAS group and traditional perioperative treatment group.The time of postoperative bowel sounds,the time of first exhaust and defecation,the proportion of antibiotic-related diarrhea and surgical site infection(SSI)were recorded.Stools were collected before operation,first time after operation,1,2 weeks and 1 month after operation.16S rRNA sequencing method was used to identify the diversity and species of gut microbiota.The diversity index of intestinal flora in the perioperative period and changes in the proportion of probiotics(bifidobacterium and lactobacillus)were compared.Results The appearance time of bowel sounds,the first exhaust and defecation time[(16.25±6.41)h,(23.95±6.02)h,(34.95±9.34)h]in ERAS group were significantly earlier than those in the traditional treatment group[(22.3±6.49)h,(28.45±7.12)h,(48.1±15.64)h],and the difference was statistically significant(P<0.05).The incidence of antibiotic-related diarrhea was higher in the traditional treatment group(3/40)than in ERAS group(1/40),but the difference was not statistically significant(P>0.05).The ratio of postoperative SSI was slightly higher in ERAS group,but the difference was not statistically significant(P>0.05).In the perioperative period,the intestinal flora diversity index(Chao1 and Shannon index)and the proportion of probiotics(lactobacillus acidophilus and bifidobacterium)were not significantly different between the two groups before surgery(P>0.05);while at the first time,one week,2 weeks after the operation,and 1 month after the operation,ERAS group was higher

关 键 词：加速康复外科(ERAS) 腹腔镜胃癌手术 肠道菌群 

分 类 号：R735.2[医药卫生—肿瘤]