联合益生菌的快速肠道准备对结直肠癌术后肠道黏膜屏障功能的影响

目的 观察联合益生菌的快速肠道准备方法的有效性及对结直肠癌术后肠道黏膜屏障功能的影响.方法 将60例行择期结直肠癌根治性手术的患者按硬币法随机化原则分为试验组（30例）和对照组（30例）.对照组采用传统的3 d肠道准备方法,试验组在使用恒康正清快速1 d肠道准备的基础上添加益生菌口服,2g/d,至少5 d.术后接受等氮量等热卡营养支持.术中观察肠道清洁度;光镜下观察肠黏膜形态学变化;免疫组织化学染色检测肠黏膜occludin蛋白和IgA的表达;检测术后第1天和第7天全血细菌DNA片段及术后第7天血清C反应蛋白浓度;观察体温、心率、外周血白细胞计数以及全身炎性反应综合征（SIRS）和吻合口瘘的发生情况.结果 试验组和对照组清肠效果的优、良率分别为90.0%和93.3%（P=0.314）;两组手术标本黏膜形态、绒毛高度、隐窝深度的差异无统计学意义.术后第7天PCR检测全血细菌DNA阳性者试验组2例（3.3%）,对照组有8例（26.67%）,差异有统计学意义（P=0.003）.试验组和对照组手术标本中结肠上皮occludin表达分别为（19.32±2.40）%和（16.21±2.54）%（P=0.025）;IgA表达分别为（7.60±1.48）%和（5.29±-1.57）%（P=0.031）;差异均有统计学意义.两组术后分别有24例（80.0%）和26例（86.7%）出现SIRS,分别各有2例（6.67%）出现吻合口瘘,差异均无统计学意义（P＞0.05）.结论 联合益生菌的快速肠道准备方法有效可行,且有利于结直肠癌术后肠道黏膜屏障功能的保护,减少术后早期炎性反应.

Effect of bowel preparation with probiotics on intestinal barrier after surgery for colorectal cancer

Objective To study the effect of bowel preparation with probiotics on intestinal barrier function after surgery for colorectal cancer. Methods A total of 60 patients undergone colonic surgery were randomly divided into two groups:the trial group and the control group. One-day bowel preparation with probiotics was administered in trial group, while 3-day conventional bowel preparation in control group. Quality of the preparation was estimated during operation and the structure of intestinal epithelium in the colon was observed by microscope. Levels of transmembrane binding protein (occludin) and IgA in the colon were detected by immunohistochemistry method. White blood cell counts, microbial DNA, and C-reactive protein were measured before surgery and 1, 7 days after surgery. Postoperative systemic inflammation response syndrome (SIRS) and infection were evaluated. Results Good and excellent bowel preparation were achieved in 88% in the trial group and 92% in the control group (P=0.072). The expression levels of occludin and IgA of colon were significantly higher in the trial group (19.32±2.40)% and (7.60±1.48)%, respectively] compared with those of the control group (16.21 ±2.54)% and (5.29±1.57)% ,respectively]. The number of microbial DNA PCR-positive patients in the trial group was significantly less than that in the control group after operation. There were no significant differences in the rates of SIRS or complications between the two groups. Conclusion One-day bowel preparation with probiotics can maintain the intestinal barrier function after surgery of colorectal cancer,which is suitable for elective colorectal surgery.