Department of General Surgery, University Hospital of Larissa, University of Thessaly, Biopolis Campus, 41110 Larissa, Greece.
Department of Emergency Medicine, General Hospital of Larissa, 41221 Larissa, Greece.
Curr Oncol. 2024 Sep 25;31(10):5789-5801. doi: 10.3390/curroncol31100430.
Gastrectomy, a prevalent surgical procedure for gastric cancer, results in substantial alterations to the gastrointestinal tract, including reduced gastric acid production and significant modifications to the gut microbiota. These changes can impair postoperative recovery, influence metabolic functions, and predispose patients to inflammatory bowel disease (IBD). Studies have shown an increased risk of IBD, particularly Crohn's disease (CD) and ulcerative colitis (UC), in patients following gastrectomy and bariatric surgeries such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). For instance, patients undergoing RYGB have a higher hazard ratio for developing CD, while SG patients show an increased risk for UC. The surgical alteration of the gastrointestinal tract promotes dysbiosis, with a significant increase in pathogenic bacteria and a decrease in beneficial microbial populations. This dysbiosis can impair the intestinal mucosal barrier and promote systemic inflammation. Understanding the mechanisms behind these changes and their clinical implications is essential for developing effective postoperative management strategies. Probiotics and enhanced recovery after surgery (ERAS) protocols have shown promise in mitigating these adverse effects, improving gut microbiota balance, and enhancing patient outcomes. Further research is necessary to fully elucidate the long-term impacts of gastrectomy on gastrointestinal health and to refine therapeutic approaches for postoperative care.
胃切除术是治疗胃癌的常见手术方法，会导致胃肠道发生重大改变，包括胃酸生成减少和肠道微生物群的显著改变。这些变化会影响术后恢复、代谢功能，并使患者易患炎症性肠病（IBD）。研究表明，胃切除术和减重手术（如 Roux-en-Y 胃旁路术（RYGB）和袖状胃切除术（SG））后患者发生 IBD（尤其是克罗恩病（CD）和溃疡性结肠炎（UC））的风险增加。例如，RYGB 术后患者 CD 的发生风险比更高，而 SG 患者 UC 的风险增加。胃肠道的手术改变会促进肠道菌群失调，导致致病菌显著增加，有益微生物群减少。这种菌群失调会损害肠道黏膜屏障并促进全身炎症。了解这些变化背后的机制及其临床意义对于制定有效的术后管理策略至关重要。益生菌和术后加速康复（ERAS）方案已显示出在减轻这些不利影响、改善肠道微生物群平衡和改善患者预后方面的潜力。需要进一步的研究来充分阐明胃切除术对胃肠道健康的长期影响，并改进术后护理的治疗方法。
