消化道手术与微生物菌群的关系

Title：

The gut microbiota and gastrointestinal surgery

DOI：

10.1038/nrgastro.2016.139

Abstract：

Surgery involving the gastrointestinal tract continues to prove challenging because of the persistence of unpredictable complications such as anastomotic leakage and life-threatening infections. Removal of diseased intestinal segments results in substantial catabolic stress and might require complex reconstructive surgery to maintain the functional continuity of the intestinal tract. As gastrointestinal surgery necessarily involves a breach of an epithelial barrier colonized by microorganisms, preoperative intestinal antisepsis is used to reduce infection-related complications. The current approach to intestinal antisepsis varies widely across institutions and countries with little understanding of its mechanism of action, effect on the gut microbiota and overall efficacy. Many of the current approaches to intestinal antisepsis before gastrointestinal surgery run counter to emerging concepts of intestinal microbiota contributing to immune function and recovery from injury. Here, we review evidence outlining the role of gut microbiota in recovery from gastrointestinal surgery, particularly in the development of infections and anastomotic leak. To make surgery safer and further reduce complications, a molecular, genetic and functional understanding of the response of the gastrointestinal tract to alterations in its microbiota is needed. Methods can then be developed to preserve the health-promoting functions of the microbiota while at the same time suppressing their harmful effects.

All Authors：

Kristina Guyton,John C Alverdy

First Authors：

Kristina Guyton

Correspondence：

John C Alverdy

内容要点：

1、胃肠道手术由于吻合口瘘及可能威胁生命的感染等无法预计的并发症而变得十分困难；

2、移除肠道病灶部位导致大量分解压力，并需要复杂的重建手术以维持肠道功能的连续性；

3、由于肠道上皮屏障处定殖的大量菌群，手术前对肠道进行消毒被用于减少感染相关的并发症；

4、现有的消毒方法在不同国家及不同机构中有很大差异，且对其机制及效果的研究较少；

5、本综述介绍了肠道菌群在胃肠道手术恢复中的作用，尤其是在吻合口瘘及感染中的作用。