摘要
目的探讨围手术期肠道微生态治疗对于顽固性功能性便秘患者术后并发症发生率及胃肠道功能的影响。方法前瞻性纳入2014-2015年间在解放军南京总医院确诊顽固性功能性便秘并行金陵术治疗的198例患者，根据围手术期处理方式的不同，非随机分为常规治疗组（100例，术前常规肠道准备，术后如存在腹泻、腹胀等胃肠道症状时给予益生菌和益生元治疗）和微生态治疗组（98例，除围手术期常规处理外，术前2周开始口服益生菌和益生元，并行肠内营养；术后待恢复排气排粪后再继续予以益生菌和益生元）。记录两组患者术后并发症发生情况：于术后1、3、6和12月进行术后胃肠生活质量评分（CIQLI）和Wexner便秘评分，并记录腹泻和腹胀发生情况。结果微生态治疗组与常规治疗组患者性别、年龄、病程、症状以及手术方式和手术时间等基线资料的比较，差异无统计学意义（均P〉0．05）。微生态治疗组和常规治疗组术后总并发症发生率分别为27．6％（27／98）和37．0％（37／100），差异无统计学意义（P：0．155）；但微生态治疗组小肠炎发生率明显低于常规治疗组C2．O％（2／98）比9．0％（9／100），P=0．0341，术后住院时间也明显缩短[（7．2±3．1）d比（9．8±3．6）d，P=0．040]。术后1月，微生态治疗组患者腹泻和腹胀发生率均显著低于常规治疗组[腹泻：30．9％（29／94）比46．9％（45／96），P=0．024；腹胀：44．7％（42／94）比60．4％（58／96），P：0．030]，GIQLI明显高于常规治疗组（52．36比43．55）（P〈0．026）。术后12月时，两组患者腹泻、腹胀发生率均明显降低[腹泻：3．4％（3／89）比3．3％（3／90），P〈O．989：腹胀：6．7％（6／89）比5．6％（5／90），P=0．742]，两组差异无统计学意义（P〉0．05）。GIQLI和Wexner便秘评分均逐渐改善，两组间差异无统计学意义（均P〉0．05）。结论围手术期肠道微生态治疗可明显降低顽固性功能性便秘患者术后小肠炎发生率，缩短术后住院时间，并减轻术后早期腹胀及腹泻症状．改善术后早期的生活质量。
Objective To investigate the effects of perioperative intestinal microecological treatment on postoperative complications and gastrointestinal function in patients with refractory functional constipation by nonrandomized controlled trial. Methods A total of 198 patients with refractory functional constipation who underwent Jinling procedure in our department from 2014 to 2015 were prospectively enrolled, and were divided into conventional treatment group （n = 100, routine intestinal preparation was used before operation; probioties and prebiotics were applied if diarrhea or abdominal distention occurred after operation） and mieroecological treatment group （n = 98, routineperioperative management was applied; prohiotics, prebiotics and enteral nutrition were administered since 2 weeks before operation; probiotics and prebiotics were given again when exhaust and defecation recovered after operation）. The general clinical data, postoperative complications, gastrointestinal quality of life index （GIQLI）, Wexner constipation score, the incidence of abdominal distension and diarrhea during follow-up were collected. Results The baseline information was not significantly different between two groups （all P 〉 0.05） as well as the morbidity of postoperative complication [27.6% （27/ 98） vs 37.0% （37/100）, P= 0.1551. Compared with conventional treatment group, microecological treatment group had obviously lower incidence of enteritis [2.0% （2/98） vs. 9.0% （9/100）, P = 0.034] and shorter postoperative hospital stay [（7.2 ± 3.1） d vs. （9.8 ± 3.6） d, P= 0.0d0]. The incidences of diarrhea and abdominal distension in microecological treatment group were obviously lower than those in conventional treatment group [30.9% （29/94） vs. 46.9% （45/96）, P = 0.024; 44.7%（42/94） vs. 60.4%（58/96）, P = 0.0301 at postoperative 1-month. Compared with conventional treatment group, microecological treatment group had obviously higher GIQLI （52.36 vs. 43.55, P = 0.026） at postoperative 1-month. At postoperative 12-month, the incidences of diarrhea and abdominal distension decreased obviously in both two groups but without significant differences [diarrhea： 3.4% （3/89） vs. 3.3%（3/90）, P = 0.989; abdominal distention： 6.7% （6/89） vs. 5.6% （5/90）, P = 0.742]. GIQL1 and Wexner score were improved but without significant differences as well （all P 〉 0.05）. Conslusion Perioperative intestinal microecological treatment can obviously reduce the incidences of postoperative enteritis, early abdominal distension and early diarrhea, improve the postoperative early GIQLI, and shorten postoperative hospital stay.
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2017年第12期1365-1369,共5页
Chinese Journal of Gastrointestinal Surgery
基金
全军临床高新技术重大项目（2010gxjs025）
江苏省临床医学科技专项基金资助项目（BL2012006）
关键词
顽固性功能性便秘
肠道微生态治疗
术后并发症
胃肠功能
生活质量
Refractoryfunctionalconstipation
Intestinalmicroecologicaltreatment
Postoperativecomplications
Gastrointestinal function
Quality of life
