微生态制剂防治腹腔镜辅助巨结肠Soave根治术患儿围术期小肠结肠炎的临床效果

李伟坚　李志雄　陈锐源　陈江谊　冯燕琼　陆金荣

【摘要】 目的：探究微生態制剂防治腹腔镜辅助巨结肠Soave根治术围术期患儿小肠结肠炎的临床效果。方法：选取2017年1月-2019年12月在本院行腹腔镜辅助巨结肠Soave根治术的先天性巨结肠患儿84例，采用随机数表法将其分为A、B组，各42例。A组患儿术前准备按照传统方法（即术前口服肠道抗菌药），B组患儿于术前5 d开始口服肠道微生物制剂（枯草杆菌二联活菌颗粒）替代术前抗菌药，术后24 h起继续口服枯草杆菌二联活菌颗粒至术后第7天。对比两组患儿入院时、术后第7天肠道菌群数量、炎症反应指标以及营养指标，并统计两组术后小肠结肠炎的发生情况。结果：术后7 d，两组患儿的细菌、球菌及杆菌总数均明显高于入院时（P<0.05），且B组上述指标均明显高于A组（P<0.05）;B组杆球菌比值与入院时比较，差异无统计学意义（P>0.05）。术后7 d，B组的血清C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）以及白细胞介素-6（IL-6）均明显低于A组（P<0.05）。A组术后7 d各营养指标水平均明显低于入院时（P<0.05）;B组术后7 d各营养指标水平与入院时相比，差异均无统计学意义（P>0.05），且B组术后7 d各指标水平均显著高于A组（P<0.05）。B组的小肠结肠炎发生率为7.14%，低于A组的23.81%（P<0.05）。结论：将微生态制剂应用于腹腔镜辅助巨结肠Soave根治术围术期患儿中，可有效纠正其肠道菌群失调现象，减少炎症反应并改善营养状况，降低小肠结肠炎的发生率。

【关键词】 微生态制剂 先天性巨结肠 Soave根治术 围术期 小肠结肠炎

Clinical Effect of Probiotics on Preventing Perioperative Enterocolitis in Children Undergoing Laparoscopic-assisted Soave Radical Resection of Megacolon/LI Weijian， LI Zhixiong， CHEN Ruiyuan， CHEN Jiangyi， FENG Yanqiong， LU Jinrong. //Medical Innovation of China， 2021， 18（23）： 0-022

[Abstract] Objective： To explore the clinical effect of probiotics on preventing perioperative enterocolitis in children undergoing laparoscopic-assisted Soave radical resection of megacolon. Method： A total of 84 children with congenital megacolon who underwent laparoscopic-assisted Soave radical resection in the hospital from January 2017 to December 2019 were enrolled. They were divided into group A and B by random number table method， 42 cases in each group. The group A was treated with traditional method （oral intestinal antibacterial before surgery）， while group B was treated with intestinal probiotics （Combined Bacillus Subtilis and Enterococcus Faecium Granules with Multivitamines， Live） at 5 d before surgery in place of preoperative antibacterial， and then treated with oral Combined Bacillus Subtilis and Enterococcus Faecium Granules with Multivitamines， Live at 24 h after surgery till the 7th day after surgery. The differences in number of intestinal floras， inflammatory response indexes and nutritional indexes at admission and 7 d after surgery were compared and analyzed between the two groups， the incidence of postoperative enterocolitis in both groups was statistically analyzed. Result： 7 d after surgery， the total number of bacteria， cocci and bacilli in the two groups were significantly higher than those at admission （P<0.05）; and the above indicators in group B were significantly higher than those in group A （P<0.05）; the ratio of bacillus in group B did not change significantly compared with that at admission （P>0.05）. 7 d after surgery， concentrations of serum C-reactive protein （CRP）， tumor necrosis factor-α （TNF-α） and interleukin-6 （IL-6） in group B were significantly lower than those in group A （P<0.05）; 7 d after surgery， the levels of all nutrition indexes in group A were significantly lower than those at admission （P<0.05）; 7 d after surgery， there was no statistical significance in the level of nutritional indexes in group B compared with at admission （P>0.05）; 7 d after surgery， the levels of all nutrition indexes in group B were significantly higher than those in group A （P<0.05）. The incidence of enterocolitis in group B was 7.14%， lower than 23.81% in group A （P<0.05）. Conclusion： The application of probiotics in perioperative children undergoing laparoscopic-assisted Soave radical resection of megacolon can effectively correct intestinal flora imbalance， reduce inflammation response， improve nutritional status， and reduce the incidence of enterocolitis.

[Key words] Probiotics Congenital megacolon Soave radical resection Perioperative period Enterocolitis

First-author’s address： Jiangmen Central Hospital， Jiangmen 529000， China

doi：10.3969/j.issn.1674-4985.2021.23.005

先天性巨结肠是小儿临床中较为常见的消化道畸形疾病，其主要机制为肠神经节细胞减少或缺如，引起肠壁神经功能紊乱，当肠管痉挛和收缩时，近端肠管内容物无法继续向前推进，结肠扩张加剧，导致患儿出现或轻或重的腹胀[1]。……