Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Ann Nutr Metab. 2017;71 Suppl 1:23-30. doi: 10.1159/000479920. Epub 2017 Sep 28.
Postoperative infectious complication (POIC) is one of the most common complications following highly invasive abdominal surgeries, such as hepatectomy, esophagectomy, and pancreatoduodenectomy. The surgical stress temporarily deteriorates the intestinal microenvironment, and the fecal concentrations of beneficial bacteria such as Bifidobacterium and Lactobacillus decrease following highly invasive abdominal surgery. In parallel with these changes, the concentrations of fecal short-chain fatty acids (SCFAs) such as acetic acid, propionic acid, and butyric acid also decrease after surgery. In contrast, the fecal concentration of lactic acid increases under this condition because of the deterioration of the metabolism from lactic acid to SCFAs by normal intestinal microflora. Decreased fecal concentration of SCFAs may lead to an impaired intestinal barrier function under stressful condition. Translocation of bacteria from the gut to lymphatic and bloodstream leads to bacteremia and subsequent POICs. The incidence of POICs in patients with unhealthy intestinal microflora before surgery may be more because their intestine is more susceptible to bacterial translocation induced by surgical stress. Therefore, improving the intestinal microenvironment and intestinal barrier function before surgery is crucial to prevent POICs following highly invasive abdominal surgeries. In this regard, the use preoperative synbiotics therapy may be one of the effective ways because it has been shown to improve intestinal microflora, increase fecal SCFAs, prevent bacterial translocation, and reduce the incidence of POICs in several randomized controlled trial in patients undergoing highly invasive abdominal surgeries.
术后感染性并发症（POIC）是肝切除术、食管切除术和胰十二指肠切除术等高度侵袭性腹部手术后最常见的并发症之一。手术应激会暂时恶化肠道微环境，高度侵袭性腹部手术后有益菌（如双歧杆菌和乳酸菌）的粪便浓度会降低。与此变化平行的是，粪便短链脂肪酸（SCFA）如乙酸、丙酸和丁酸的浓度也会在手术后降低。相比之下，由于正常肠道微生物群中乳酸到 SCFA 的代谢恶化，这种情况下粪便中乳酸的浓度会增加。SCFA 粪便浓度降低可能导致在应激条件下肠道屏障功能受损。细菌从肠道向淋巴和血流易位会导致菌血症和随后的 POIC。手术前肠道微生物群不健康的患者发生 POIC 的可能性更高，因为他们的肠道更容易受到手术应激引起的细菌易位的影响。因此，改善手术前的肠道微环境和肠道屏障功能对于预防高度侵袭性腹部手术后的 POIC 至关重要。在这方面，术前使用合生剂治疗可能是一种有效的方法，因为它已被证明可以改善肠道微生物群，增加粪便 SCFA，预防细菌易位，并降低接受高度侵袭性腹部手术的患者的 POIC 发生率。
