West China School of Nursing, Sichuan University/Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
Nursing Key Laboratory of Sichuan Province, Chengdu, People's Republic of China.
BMC Gastroenterol. 2021 Nov 25;21(1):446. doi: 10.1186/s12876-021-02035-6.
Accumulating evidence suggests a critical role of intestinal dysbacteriosis in surgical site infections and anastomotic leakage after abdominal surgery. However, a direct correlation between pre-existing dysbacteriosis and postoperative infectious complications has not yet been established clinically.
A total of 353 consecutive patients who underwent colorectal cancer (CRC) surgery were enrolled. Gram-stained faecal smears were tested at admission and the first defecation after surgery. Intestinal dysbacteriosis was graded into three groups: normal or slightly decreased intestinal microflora (grade 1), moderate dysbacteriosis (grade 2), and severe dysbacteriosis (grade 3). Clinical outcomes were postoperative infections and anastomotic leakage within 30 days after surgery.
At the preoperative assessment, 268 (75.9%) patients had normal or slightly decreased intestinal microflora, 58 (16.4%) patients had moderate dysbacteriosis, and 27 (7.6%) patients had severe dysbacteriosis. The patients with preoperative dysbacteriosis had a higher rate of early postoperative diarrhoea (grade 2: OR = 4.53, 95% CI 2.28-9.00, grade 3: OR = 4.52, 95% CI 1.81-11.31), total complications (grade 3 40.7% vs. grade 2 25.9% vs. grade 1 12.7%, P < 0.001), and anastomotic leakage (grade 3 11.1% vs. grade 2 5.2% vs. grade 1 1.5%, P = 0.002). An interaction effect among preoperative dysbacteriosis and early postoperative diarrhoea on total complications was observed in rectal cancer patients (P for interaction = 0.007).
An imbalance of the intestinal microbiome exists in a considerable proportion of CRC patients before surgery. Preoperative dysbacteriosis is associated with higher rates of early postoperative diarrhoea, which further correlates with infectious complications and anastomotic leakage. However, the contribution of preoperative dysbacteriosis to the occurrence of anastomotic leakage needs to be clarified in further studies. Trial registration ChiCTR, ChiCTR1800018755. Registered 8 October 2018-Retrospectively registered, http://www.chictr.org.cn/ChiCTR1800018755 .
越来越多的证据表明，肠道菌群失调在腹部手术后的手术部位感染和吻合口漏中起着关键作用。然而，临床尚未确定术前菌群失调与术后感染性并发症之间存在直接相关性。
共纳入 353 例接受结直肠癌（CRC）手术的患者。入院时和手术后首次排便时检测革兰氏染色粪便涂片。肠道菌群失调分为 3 组：正常或肠道微生物群略有减少（1 级）、中度菌群失调（2 级）和严重菌群失调（3 级）。临床结果为术后 30 天内的感染和吻合口漏。
术前评估时，268 例（75.9%）患者肠道微生物群正常或略有减少，58 例（16.4%）患者中度菌群失调，27 例（7.6%）患者严重菌群失调。术前菌群失调的患者术后早期腹泻发生率更高（2 级：OR=4.53，95%CI 2.28-9.00；3 级：OR=4.52，95%CI 1.81-11.31）、总并发症发生率更高（3 级：40.7%；2 级：25.9%；1 级：12.7%，P<0.001）和吻合口漏（3 级：11.1%；2 级：5.2%；1 级：1.5%，P=0.002）。在直肠癌患者中观察到术前菌群失调与术后早期腹泻之间存在相互作用（交互效应 P 值=0.007）。
相当一部分 CRC 患者在术前存在肠道微生物组失衡。术前菌群失调与术后早期腹泻发生率较高相关，进而与感染性并发症和吻合口漏相关。然而，术前菌群失调与吻合口漏发生的关系还需要进一步研究加以明确。
ChiCTR，ChiCTR1800018755。注册日期：2018 年 10 月 8 日-回顾性注册，http://www.chictr.org.cn/ChiCTR1800018755。
