背景:结直肠癌术后并发症与肠道微生物组相关。然而,使用口服制剂或直肠灌肠的机械肠道准备对术后感染的影响尚不清楚.本研究旨在比较口服制剂和直肠灌肠对肠道菌群和术后并发症的影响。
方法:这个开放标签试验RCT在美国国家癌症研究所进行,维尔纽斯,立陶宛。计划进行原发性吻合术的择期切除的左侧结直肠癌患者以1:1的比例随机分配为术前机械肠道准备,包括口服准备或直肠灌肠。手术前收集粪便样本,并在术后第6天和第30天进行16SrRNA基因测序分析。主要结果是术后第6天各组之间的β多样性差异。
结果:40名参与者被随机分为口服制剂(20)或直肠灌肠(20)。两组的微生物组组成变化相似,术后第6天β-多样性无差异。术后发生感染12例(32%),研究组之间没有差异。感染患者放线菌科细菌的丰度增加,放线菌属,Sutterilla未培养的物种,和粪肠球菌。
结论:口服准备或直肠灌肠的机械肠道准备导致类似的菌群失调。术后感染的患者在术后第6天表现出不同的肠道微生物组组成,其特征是放线菌科细菌的丰度增加,放线菌属,Sutterilla未培养的物种,和粪肠球菌。
背景:NCT04013841(http://www.clinicaltrials.gov)。
BACKGROUND: Postoperative complications after colorectal cancer surgery have been linked to the gut microbiome. However, the impact of mechanical bowel preparation using oral preparation agents or rectal
enema on postoperative infections remains poorly understood. This study aimed to compare the impact of oral preparation and rectal
enema on the gut microbiome and postoperative complications.
METHODS: This open-label pilot RCT was conducted at the National Cancer Institute, Vilnius, Lithuania. Patients with left-side colorectal cancer scheduled for elective resection with primary anastomosis were randomized 1 : 1 to preoperative mechanical bowel preparation with either oral preparation or rectal
enema. Stool samples were collected before surgery, and on postoperative day 6 and 30 for 16S rRNA gene sequencing analysis. The primary outcome was difference in β-diversity between groups on postoperative day 6.
RESULTS: Forty participants were randomized to oral preparation (20) or rectal
enema (20). The two groups had similar changes in microbiome composition, and there was no difference in β-diversity on postoperative day 6. Postoperative infections occurred in 12 patients (32%), without differences between the study groups. Patients with infections had an increased abundance of bacteria from the Actinomycetaceae family, Actinomyces genus, Sutterella uncultured species, and Enterococcus faecalis species.
CONCLUSIONS: Mechanical bowel preparation with oral preparation or rectal
enema resulted in similar dysbiosis. Patients who experienced postoperative infections exhibited distinct gut microbiome compositions on postoperative day 6, characterized by an increased abundance of bacteria from the Actinomycetaceae family, Actinomyces genus, Sutterella uncultured species, and Enterococcus faecalis species.
BACKGROUND: NCT04013841 (http://www.clinicaltrials.gov).