鼠李糖乳杆菌 GG 对保留幽门胰十二指肠切除术后早期术后结局的影响：一项随机试验。
Effects of Lactobacillus rhamnosus GG on early postoperative outcome after pylorus-preserving pancreatoduodenectomy: a randomized trial.
机构信息
Department of Clinical Nutrition and Dietetics, Medical University of Gdansk, Poland; Home Enteral and Parenteral Nutrition Unit, General Surgery, Nicolaus Copernicus Hospital, Gdansk, Poland.
出版信息
Eur Rev Med Pharmacol Sci. 2021 Jan;25(1):397-405. doi: 10.26355/eurrev_202101_24407.
OBJECTIVE
Pancreatoduodenectomy (PPPD) remains one of the most complex surgical procedures with high complication rates. Infectious complications, postoperative ileus and delayed gastric emptying in the perioperative period have a significant impact on the recovery from the treatment. Probiotics (PB) are known to have a beneficial effect as supportive therapy in major abdominal surgery but the evidence in pancreatic surgery is still limited. The aim of the study was to assess the influence of postoperative administration of PB on the early outcomes after PPPD.
PATIENTS AND METHODS
Forty patients undergoing pylorus-preserving PPPD were enrolled to prospective trial and randomized in two groups: A - control group (n=20) receiving standard nutrition and B - probiotic group (n=20) treated additionally with Lactobacillus rahmnosus GG (L. rhamnosus GG) in the postoperative period from the day of the surgery for 30 days. Gastrointestinal motility, infection complications, length of hospital stay, and mortality were compared in the perioperative period and during 2 follow-up (i.e., after 14 and 30 days).
RESULTS
There were no significant differences in mortality and infectious complications between groups. The length of hospital stay was shorter in the probiotic group compared to control (10 days vs. 8, respectively). The positive effect of L. rhamnosus GG on gastrointestinal tract's motility was observed, including earlier recurrence of postoperative bowel movements (group B: after 3.75 days vs. group A: 2.15 days), passing gasses (group B after 4 days vs. group A 2.9 days) and the first postoperative stool (group B after 5.84 days vs. group A 3.85 days). L. rhamnosus GG improved the appetite in postoperative day 1, 3, 5, 7 and 30 days after the surgery.
CONCLUSIONS
L. rhamnosus GG improves the function of the gastrointestinal tract after major pancreatic surgery and may reduce the length of hospital stay.
目的
胰十二指肠切除术（PPPD）仍然是最复杂的手术之一，具有很高的并发症发生率。围手术期的感染并发症、术后肠梗阻和胃排空延迟对治疗的恢复有重大影响。益生菌（PB）作为一种支持性治疗方法，在大型腹部手术中具有有益的作用，但在胰腺手术中的证据仍然有限。本研究旨在评估 PPPD 术后给予 PB 对患者术后早期结果的影响。
患者和方法
40 名接受保留幽门胰十二指肠切除术的患者被纳入前瞻性试验并随机分为两组：A-对照组（n=20）接受标准营养治疗，B-益生菌组（n=20）在术后接受鼠李糖乳杆菌 GG（L. rhamnosus GG）治疗，从手术当天开始持续 30 天。比较围手术期和 2 次随访（即术后 14 天和 30 天）期间的胃肠动力、感染并发症、住院时间和死亡率。
结果
两组间死亡率和感染并发症无显著差异。益生菌组的住院时间短于对照组（分别为 10 天和 8 天）。L. rhamnosus GG 对胃肠道动力有积极影响，包括术后排便恢复较早（B 组：术后第 3.75 天 vs. A 组：第 2.15 天）、排气较早（B 组：术后第 4 天 vs. A 组：第 2.9 天）和首次术后排便较早（B 组：术后第 5.84 天 vs. A 组：第 3.85 天）。L. rhamnosus GG 在术后第 1、3、5、7 和 30 天改善了食欲。
结论
L. rhamnosus GG 改善了大型胰腺手术后胃肠道的功能，并可能缩短住院时间。
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