Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
Department of Medical Microbiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
Ann Surg. 2019 May;269(5):911-916. doi: 10.1097/SLA.0000000000002651.
The aim of the present study is to investigate the association of gut microbiota, depending on treatment method, with the development of colorectal anastomotic leakage (AL).
AL is a major cause for morbidity and mortality after colorectal surgery, but the mechanism behind this complication still is not fully understood.
Bacterial DNA was isolated from 123 "donuts" of patients where a stapled colorectal anastomosis was made and was analyzed using 16S MiSeq sequencing. In 63 patients, this anastomosis was covered with a C-seal, a bioresorbable sheath stapled to the anastomosis.
In non-C-seal patients, AL development was associated with low microbial diversity (P = 0.002) and correspondingly with a high abundance of the dominant Bacteroidaceae and Lachnospiraceae families (P = 0.008 and 0.010, respectively). In C-seal samples, where AL rates were slightly higher (25% vs 17%), an association with the gut microbiota composition was almost undetectable. Only a few opportunistic pathogenic groups of low abundance were associated with AL in C-seal patients, in particular Prevotella oralis (P = 0.007).
AL in patients without a C-seal can be linked to the intestinal microbiota, in particular with a low microbial diversity and a higher abundance of especially mucin-degrading members of the Bacteroidaceae and Lachnospiraceae families. In C-seal patients, however, it seems that any potential protective benefits or harmful consequences of the gut microbiota composition in regard to wound healing are negated, as progression to AL is independent of the initially dominant bacterial composition.
本研究旨在探讨基于治疗方法的肠道微生物群与结直肠吻合口漏（AL）发展之间的关系。
AL 是结直肠手术后发病率和死亡率的主要原因，但这一并发症的发病机制尚未完全阐明。
从 123 例吻合器吻合的“甜甜圈”中分离出细菌 DNA，并使用 16S MiSeq 测序进行分析。在 63 例患者中，该吻合口用 C 形密封物覆盖，这是一种生物可吸收的套管，用吻合器固定在吻合口上。
在非 C 形密封患者中，AL 的发展与微生物多样性低（P=0.002）相关，相应地，优势拟杆菌科和lachnospiraceae 科的丰度较高（P=0.008 和 0.010）。在 C 形密封样本中，AL 发生率略高（25%比 17%），与肠道微生物群组成的相关性几乎无法检测到。只有少数低丰度的机会性病原体群与 C 形密封患者的 AL 相关，特别是普氏菌属（P=0.007）。
没有 C 形密封的患者的 AL 可以与肠道微生物群相关，特别是与微生物多样性低和细菌多样性低有关。特别是，拟杆菌科和lachnospiraceae 科的成员丰度较高，这些成员能降解黏蛋白。然而，在 C 形密封患者中，肠道微生物群组成对伤口愈合的任何潜在保护作用或有害后果似乎都被否定了，因为 AL 的进展与最初的优势细菌组成无关。
