Department of General-, Visceral- and Transplant Surgery, Charité Campus Virchow, Augustenburger Platz 1, 13353 Berlin, Germany.
Benef Microbes. 2012 Sep;3(3):237-44. doi: 10.3920/BM2012.0006.
Liver regeneration is a prerequisite for extended liver surgery. Several studies have shown that the bacterial gut flora is able to modulate liver function. Previously we observed that synbiotics could partly reverse the impaired mitosis rate of hepatocytes in a rat model of synchronous liver resection and colon anastomosis. The effect of synbiotics on liver function after hepatic resection has not been analysed yet. A prospective randomised double-blind pilot trial was undertaken in 19 patients scheduled for right hepatectomy. All patients received enteral nutrition immediately post-operatively. Comparison was made between a group receiving a combination of four probiotics and four fibres and a placebo group receiving the fibres only starting the day before surgery and continuing for 10 days. Primary study endpoint was the liver function capacity measured by 13C-methacetin breath test and indocyanine green plasma disappearance rate. Portal vein flow, liver volumetry, laboratory parameters for liver function, length of hospital stay, post-operative complications and side effects of synbiotic therapy were recorded. Liver function capacity was comparable in both groups. Complications had a negative impact on liver function. Because complications were more severe in the verum group, a sub-analysis was performed. In case of an uncomplicated course, liver function capacity was better in the patients with synbiotics. No severe side effects occurred. Synbiotics might be able to increase liver function capacity in patients after liver resection, but patient numbers were too small and the clinical courses too heterogeneous to draw any definite conclusions.
肝脏再生是扩大肝手术的前提。几项研究表明，肠道菌群能够调节肝脏功能。先前我们观察到，合生素可部分逆转同步肝切除和结肠吻合大鼠模型中肝细胞有丝分裂率受损的情况。合生素对肝切除术后肝功能的影响尚未进行分析。我们对 19 例行右半肝切除术的患者进行了前瞻性随机双盲试点试验。所有患者术后立即接受肠内营养。一组患者接受四种益生菌和四种纤维的联合治疗，另一组患者仅在手术前一天开始接受纤维治疗，并持续 10 天。主要研究终点是通过 13C-美沙西丁呼气试验和吲哚菁绿血浆清除率测量的肝功能容量。记录门静脉流量、肝体积、肝功能的实验室参数、住院时间、术后并发症和合生素治疗的副作用。两组的肝功能容量相当。并发症对肝功能有负面影响。由于真药组的并发症更严重，因此进行了亚分析。在无并发症的情况下，合生素组患者的肝功能容量更好。没有发生严重的副作用。合生素可能能够增加肝切除术后患者的肝功能容量，但患者数量太少，临床过程太异质，无法得出任何明确的结论。
