术前粪便有机酸谱可密切预测肝外胆管切除的大肝切除术后感染性并发症的发生率：粪便乙酸加丁酸减乳酸差值的重要性

Profile of preoperative fecal organic acids closely predicts the incidence of postoperative infectious complications after major hepatectomy with extrahepatic bile duct resection: Importance of fecal acetic acid plus butyric acid minus lactic acid gap.

作者信息

Yokoyama Yukihiro, Mizuno Takashi, Sugawara Gen, Asahara Takashi, Nomoto Koji, Igami Tsuyoshi, Ebata Tomoki, Nagino Masato

机构信息

Department of Surgery, Division of Surgical Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

出版信息

Surgery. 2017 Oct;162(4):928-936. doi: 10.1016/j.surg.2017.04.022. Epub 2017 Jul 3.

DOI:10.1016/j.surg.2017.04.022

PMID:28684159

Abstract

BACKGROUND

To investigate the association between preoperative fecal organic acid concentrations and the incidence of postoperative infectious complications in patients undergoing major hepatectomy with extrahepatic bile duct resection for biliary malignancies.

METHODS

The fecal samples of 44 patients were collected before undergoing hepatectomy with bile duct resection for biliary malignancies. The concentrations of fecal organic acids, including acetic acid, butyric acid, and lactic acid, and representative fecal bacteria were measured. The perioperative clinical characteristics and the concentrations of fecal organic acids were compared between patients with and without postoperative infectious complications.

RESULTS

Among 44 patients, 13 (30%) developed postoperative infectious complications. Patient age and intraoperative bleeding were significantly greater in patients with postoperative infectious complications compared with those without postoperative infectious complications. The concentrations of fecal acetic acid and butyric acid were significantly less, whereas the concentration of fecal lactic acid tended to be greater in the patients with postoperative infectious complications. The calculated gap between the concentrations of fecal acetic acid plus butyric acid minus lactic acid gap was less in the patients with postoperative infectious complications (median 43.5 vs 76.1 μmol/g of feces, P = .011). Multivariate analysis revealed that an acetic acid plus butyric acid minus lactic acid gap <60 μmol/g was an independent risk factor for postoperative infectious complications with an odds ratio of 15.6; 95% confidence interval 1.8-384.1.

CONCLUSION

The preoperative fecal organic acid profile (especially low acetic acid, low butyric acid, and high lactic acid) had a clinically important impact on the incidence of postoperative infectious complications in patients undergoing major hepatectomy with extrahepatic bile duct resection.

摘要

背景

探讨行肝外胆管切除的大肝癌切除术治疗胆道恶性肿瘤患者术前粪便有机酸浓度与术后感染性并发症发生率之间的关联。

方法

收集44例行肝外胆管切除的大肝癌切除术治疗胆道恶性肿瘤患者的粪便样本。测定粪便中乙酸、丁酸和乳酸等有机酸浓度以及代表性粪便细菌。比较有和无术后感染性并发症患者的围手术期临床特征和粪便有机酸浓度。

结果

44例患者中，13例（30%）发生术后感染性并发症。与无术后感染性并发症的患者相比，有术后感染性并发症的患者年龄和术中出血量显著更大。术后感染性并发症患者的粪便乙酸和丁酸浓度显著更低，而粪便乳酸浓度则倾向于更高。术后感染性并发症患者粪便乙酸加丁酸减去乳酸浓度的计算差值更小（中位数43.5 vs 76.1 μmol/g粪便，P = 0.011）。多因素分析显示，乙酸加丁酸减去乳酸浓度差值<60 μmol/g是术后感染性并发症的独立危险因素，比值比为15.6；95%置信区间为1.8 - 384.1。