Karitnig Robert, Bogner Andreas, Jahn Nora, Vlachos Christos, Lederer Andri, Geisler Antonia, Sucher Robert, Hau Hans Michael
Department of General, Visceral and Transplant Surgery, Medical University of Graz, 8010 Graz, Austria.
Department for Anesthesiology and Intensive Care Medicine, Medical University of Graz, 8010 Graz, Austria.
Medicina (Kaunas). 2025 Jun 10;61(6):1068. doi: 10.3390/medicina61061068.
The gut-liver axis plays a crucial role in the development of post-surgical infections. Surgery-induced dysbiosis can lead to increased bacterial translocation, impairing the liver's detoxification capacity and negatively affecting surgical outcomes. Following liver surgery, approximately a third of the patients develop bacterial infections, with a high risk of bacteremia or even sepsis-related liver failure and death. The potential advantages of administering pro- or synbiotics before/after surgery remain a topic of discussion. Therefore, a systematic review of randomized clinical trials comparing patients with and without supplementation and their outcomes and effects after liver resection (LR) or liver transplantation (LT) was conducted. A computer-based search of electronic databases was conducted to gather randomized controlled trials (RCTs) that focused on probiotic/synbiotic use during the perioperative period for liver surgery patients. Two researchers independently screened the studies, extracted the data, evaluated the risk of bias, and performed a meta-analysis using RevMan Web. Our research revealed 19 relevant randomized controlled studies that included a total of 1698 patients on the perioperative use of pro-/symbiotic administration in liver surgery. Eight studies were performed on liver transplantation (LT), and 11 studies were performed for liver resection (LR). The results of the meta-analysis demonstrated that the probiotic group exhibited lower rates of postoperative infectious complications (OR = 0.34; 95%CI 0.25 to 0.45; < 0.0001), hospital stay duration (SMD = -0.13; 95%CI -0.25 to -0.00; = 0.05), lower serum endotoxin levels (SMD = -0.39%CI -0.59 to -19; < 0.0001), and white blood cell counts (SMD = -SMD = -0.35; 95%CI -0.56 to -0.13; = 0.002) compared to the control group. Further, with regard to liver function, we observed significant postoperative differences in alanine aminotransferase (ALT)-levels (SMD = -0.46; 95%CI -0.63 to -0.29; < 0.0001), aspartate aminotransferase (AST) levels (SMD = -0.53; 95%CI -0.71 to -0.34; < 0.0001), bilirubin levels (SMD = -0.35; 95%CI -0.50 to -0.19; < 0.0001), and international ratio (INR) levels (SMD = -0.1; 95%CI -0.12 to -0.08; ≤ 0.0001), favoring the symbiotic group compared to the control group. The use of pro-/synbiotics during the perioperative period reduces the risk of postoperative infections, support postoperative liver function, and recovery and shortens hospital stays for liver surgery patients. However, they do not appear to particularly aid in inflammation reduction.
肠-肝轴在术后感染的发生发展中起着关键作用。手术引起的生态失调可导致细菌易位增加,损害肝脏的解毒能力,并对手术结果产生负面影响。肝脏手术后,约三分之一的患者会发生细菌感染,有发生菌血症甚至脓毒症相关肝衰竭及死亡的高风险。术前/术后给予益生菌或合生元的潜在益处仍是一个讨论话题。因此,我们对比较肝切除(LR)或肝移植(LT)术后补充与未补充益生菌或合生元的患者及其结局和影响的随机临床试验进行了系统评价。通过计算机检索电子数据库,收集聚焦于肝手术患者围手术期使用益生菌/合生元的随机对照试验(RCT)。两名研究人员独立筛选研究、提取数据、评估偏倚风险,并使用RevMan Web进行荟萃分析。我们的研究发现了19项相关随机对照研究,共纳入1698例肝手术围手术期使用益生菌/合生元的患者。8项研究针对肝移植(LT),11项研究针对肝切除(LR)。荟萃分析结果表明,与对照组相比,益生菌组术后感染并发症发生率较低(OR = 0.34;95%CI 0.25至0.45;< 0.0001)、住院时间较短(SMD = -0.13;95%CI -0.25至-0.00;P = 0.05)、血清内毒素水平较低(SMD = -0.39;95%CI -0.59至-0.19;< 0.0001)以及白细胞计数较低(SMD = -0.35;95%CI -0.56至-0.13;P = 0.002)。此外,在肝功能方面,我们观察到术后丙氨酸氨基转移酶(ALT)水平(SMD = -0.46;95%CI -0.63至-0.29;< 0.0001)、天冬氨酸氨基转移酶(AST)水平(SMD = -0.53;95%CI -0.71至-0.34;< 0.0001)、胆红素水平(SMD = -0.35;95%CI -0.50至-0.19;< 0.0001)和国际标准化比值(INR)水平(SMD = -0.1;95%CI -0.12至-0.08;P ≤ 0.0001)存在显著差异,与对照组相比,合生元组更具优势。围手术期使用益生菌/合生元可降低肝手术患者术后感染风险,支持术后肝功能恢复并缩短住院时间。然而,它们似乎对减轻炎症没有特别帮助。