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目的观察大肠癌术前未口服抗生素行肠道准备的效果。方法随机将温州市肿瘤医院外科2000年8月至2003年8月收治的60例大肠癌病人分为2组。治疗组30例,术前未口服抗生素行肠道准备,其他治疗同传统方式。对照组30例,术前行传统肠道准备。2组手术前、后分别取粪便作肠道菌群分析、血细菌培养,并观察术后并发症。结果治疗组病人术后肠道菌群无明显变化,而对照组病例术后肠道菌群却发生明显变化,具体表现为大肠杆菌、肠球菌计数较治疗组明显增高(P<0.05),而双歧杆菌、乳杆菌、真杆菌计数则明显降低(P<0.05),双歧杆菌/大肠杆菌值倒置比治疗组更为明显(0.03±0.01对0.74±0.15,P<0.01)。所有病例术前血细菌培养均为阴性。治疗组术后血细菌培养阳性率、感染性并发症发生率分别为3.3%、10.0%,对照组分别为20.0%、33.3%,两组之间差异均有显著意义(P<0.05)。结论大肠癌术前肠道准备未口服抗生素可以避免肠道菌群失调、损害肠屏障功能而导致细菌易位,从而降低术后感染性并发症发生率。
Objective To observe the effect of preoperative oral administration of antibiotics on intestinal preparation in colorectal cancer. Methods A total of 60 patients with colorectal cancer who were admitted to Department of Surgery, Wenzhou Tumor Hospital from August 2000 to August 2003 were randomly divided into two groups. The treatment group of 30 cases, preoperative oral antibiotics for intestinal preparation, the other treatment with the traditional way. Control group of 30 patients, preoperative traditional bowel preparation. The two groups before and after the feces were taken for intestinal flora analysis, blood bacterial culture, and observe postoperative complications. Results There was no significant change in the intestinal microflora after operation in the treatment group, but the intestinal microflora of the control group changed significantly after operation. The count of Escherichia coli and Enterococcus was significantly higher than that of the treatment group (P <0.05) Bifidobacterium, Lactobacillus, and Eubacterium count decreased significantly (P <0.05), and Bifidobacterium / Escherichia coli count inverted more significantly than the treatment group (0.03 ± 0.01 vs 0.74 ± 0.15, P <0.01). Preoperative blood culture in all cases were negative. The positive rates of blood bacterial culture and infectious complications in the treatment group were 3.3% and 10.0%, respectively, and those in the control group were 20.0% and 33.3% respectively. There was significant difference between the two groups (P <0.05). Conclusion Preoperative gut preparation of preoperative gut without antibiotics can prevent intestinal flora imbalance, impair intestinal barrier function and lead to bacterial translocation, thus reducing the incidence of postoperative infectious complications.