肠道菌群对结直肠癌术后吻合口漏影响的研究进展  

Research progress of effect of intestinal flora on anastomotic leakage following colorectal cancer surgery

作　　者：王朝樣 林浩 张海宝[1] 巨家华 俞永江[2] WANG Chaoyang;LIN Hao;ZHANG Haibao;JU Jiahua;YU Yongjiang(The First Clinical Medical College,Lanzhou University,Lanzhou 730000,P.R.China;Department of Gastrointestinal Surgery/Hernia and Abdominal Wall Surgery,The First Hospital of Lanzhou University,Lanzhou 730000,P.R.China)

机构地区：[1]兰州大学第一临床医学院,兰州730000 [2]兰州大学第一医院胃肠及疝与腹壁外科,兰州730000

出　　处：《中国普外基础与临床杂志》2022年第11期1522-1527,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：甘肃省科技计划项目(项目编号:21JR1RA075)。

摘　　要：目的 了解肠道菌群在结直肠癌围术期的变化状况及其影响术后吻合口漏发生的机制,以改善对患者的围术期管理及找到可能有助于降低吻合口漏发生率的措施。方法 在知网、PubMed和Embase数据库中全面检索近年来有关结直肠癌围术期肠道菌群评估、吻合口愈合及吻合口漏相关研究的文献并进行综述。结果 结直肠癌围术期的多种干预措施使术后肠道菌群的多样性和丰度发生了改变,粪肠球菌、铜绿假单胞菌等条件致病菌显著增多,其通过细菌胶原酶的表达或宿主肠道基质金属蛋白酶的过度激活导致胶原蛋白降解,从而可能导致术后吻合口愈合不良甚至发生吻合口漏。结论 尽管肠道菌群在吻合口漏中作用的证据主要来自于动物实验,但也显示出了肠道菌群在结直肠癌术后吻合口漏发生过程中的潜在作用,并且可以通过围术期干预来进行调节,提示此可能为吻合口漏的预防提供一种思路。Objective To understand the changes of intestinal flora during perioperative period of colorectal cancer and the mechanism affecting the occurrence of postoperative anastomotic leakage, so as to improve perioperative management of patients and find possible measures to decrease the incidence rate of anastomotic leakage. Method The literature related to perioperative intestinal flora assessment, anastomotic healing, and anastomotic leakage of colorectal cancer in recent years was comprehensively searched in the CNKI, PubMed, and Embase databases and made an review.Results Due to the various perioperative interventions, the diversity and abundance of intestinal flora had changed after colorectal cancer surgery, and some conditional pathogenic bacteria such as Enterococcus faecalis, Pseudomonas aeruginosa, etc. increased obviously, which led to collagen degradation through the expression of bacterial collagenase or the excessive activation of matrix metalloproteinases in the host intestine, then might lead to the poor anastomotic healing and even the anastomotic leakage. Conclusion Although the evidence of effect of intestinal flora on anastomotic leakage mainly comes from animal experiments, it still shows the potential role of intestinal flora in the occurrence of anastomotic leakage after colorectal cancer surgery, and can be regulated by perioperative intervention, which suggests that it may provide a new strategy for prevention of anastomotic leakage.

关 键 词：肠道菌群 结直肠癌 围术期 吻合口漏 

分 类 号：R735.34[医药卫生—肿瘤]