Williamson Ashley J, Alverdy John C
Department of Surgery, University of Chicago, Chicago, Illinois.
Clin Colon Rectal Surg. 2021 Nov 23;34(6):439-446. doi: 10.1055/s-0041-1735276. eCollection 2021 Nov.
Despite advances in surgical technique and the expanded use of antibiotics, anastomotic leak remains a dreaded complication leading to increased hospital length of stay, morbidity, mortality, and cost. Data continues to grow addressing the importance of a functional and diverse colonic microbiome to ensure adequate healing. Individual pathogens, such as and , have been implicated in the pathogenesis of anastomotic leak. Yet how these pathogens proliferate remains unclear. It is possible that decreased microbial diversity promotes a shift to a pathologic phenotype among the remaining microbiota which may lead to anastomotic breakdown. As the microbiome is highly influenced by diet, antibiotic use, the stress of surgery, and opioid use, these factors may be modifiable at various phases of the surgical process. A large amount of data remains unknown about the composition and behavior of the "normal" gut microbiome as compared with an altered community. Therefore, targeting the gut microbiome as a modifiable factor in anastomotic healing may represent a novel strategy for the prevention of anastomotic leak.
尽管手术技术有所进步，抗生素的使用也更为广泛，但吻合口漏仍然是一种可怕的并发症，会导致住院时间延长、发病率增加、死亡率上升以及成本提高。关于功能健全且多样的结肠微生物群对确保充分愈合的重要性的数据不断增加。个别病原体，如[此处原文缺失具体病原体名称]，已被认为与吻合口漏的发病机制有关。然而，这些病原体如何增殖仍不清楚。微生物多样性降低可能促使剩余微生物群向病理表型转变，这可能导致吻合口破裂。由于微生物群受到饮食、抗生素使用、手术应激和阿片类药物使用的高度影响，这些因素在手术过程的各个阶段可能是可调节的。与改变的群落相比，关于“正常”肠道微生物群的组成和行为仍有大量未知数据。因此，将肠道微生物群作为吻合口愈合中的一个可调节因素进行靶向干预，可能代表了一种预防吻合口漏的新策略。
