Tang Gang, Zhang Linyu, Tao Jie, Wei Zhengqiang
Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Clinical Medicine, Chongqing Medical University, Chongqing, China.
Front Nutr. 2021 Aug 13;8:715788. doi: 10.3389/fnut.2021.715788. eCollection 2021.
Post-pancreaticoduodenectomy infections cause mortality, morbidity, and prolonged antibiotic use. Probiotics or synbiotics may be advantageous for preventing postoperative infections, but their benefits on pancreaticoduodenectomy outcomes are controversial. This study evaluated the efficacy of probiotics and synbiotics in pancreaticoduodenectomy. The Embase, Web of Science, PubMed, and Cochrane Library databases were comprehensively searched for randomized controlled trials (RCTs) that evaluated the effects of probiotics or synbiotics on pancreaticoduodenectomy as of April 16, 2021. Outcomes included perioperative mortality, postoperative infectious complications, delayed gastric emptying, hospital stay length, and antibiotic-use duration. The results were reported as mean differences (MDs) and relative risks (RRs) with 95% confidence intervals (CI). Six RCTs involving 294 subjects were included. Probiotic or synbiotic supplementation did not reduce the perioperative mortality (RR, 0.34; 95% CI, 0.11, 1.03), but reduced the incidences of postoperative infection (RR, 0.49; 95% CI, 0.34, 0.70) and delayed gastric emptying (RR, 0.27; 95% CI, 0.09, 0.76) and also reduced the hospital stay length (MD, -7.87; 95% CI, -13.74, -1.99) and antibiotic-use duration (MD, -6.75; 95% CI, -9.58, -3.92) as compared to the controls. Probiotics or synbiotics can prevent infections, reduce delayed gastric emptying, and shorten the hospital stay and antibiotic-use durations in patients undergoing pancreaticoduodenectomy. These findings are clinically important for promoting recovery from pancreaticoduodenectomy, reducing the incidences of antibiotic resistance and iatrogenic infections, and reducing the medical burden.
胰十二指肠切除术后感染会导致死亡、发病，并延长抗生素使用时间。益生菌或合生元可能有利于预防术后感染，但其对胰十二指肠切除术后结局的益处存在争议。本研究评估了益生菌和合生元在胰十二指肠切除术中的疗效。全面检索了Embase、Web of Science、PubMed和Cochrane图书馆数据库，以查找截至2021年4月16日评估益生菌或合生元对胰十二指肠切除术影响的随机对照试验（RCT）。结局包括围手术期死亡率、术后感染并发症、胃排空延迟、住院时间和抗生素使用时间。结果以95%置信区间（CI）的平均差（MD）和相对风险（RR）报告。纳入了6项涉及294名受试者的RCT。补充益生菌或合生元并未降低围手术期死亡率（RR，0.34；95%CI，0.11，1.03），但降低了术后感染发生率（RR，0.49；95%CI，0.34，0.70）和胃排空延迟发生率（RR，0.27；95%CI，0.09，0.76），与对照组相比，还缩短了住院时间（MD，-7.87；95%CI，-13.74，-1.99）和抗生素使用时间（MD，-6.75；95%CI，-9.58，-3.92）。益生菌或合生元可预防感染、减少胃排空延迟，并缩短胰十二指肠切除术患者的住院时间和抗生素使用时间。这些发现对于促进胰十二指肠切除术后的恢复、降低抗生素耐药性和医源性感染的发生率以及减轻医疗负担具有重要临床意义。
