[Analysis of short-term efficacy of perioperative fecal microbiota transplantation combined with nutritional support in patients with radiation-induced enteritis complicated by intestinal obstruction].

Objective: To explore the short-term efficacy of perioperative fecal microbiota transplantation combined with nutritional support in patients with radiation-induced enteritis complicated by intestinal obstruction. Methods: The cohort of this prospective cohort study comprised 45 patients (nine men and 36 women) with radiation-induced enteritis complicated by intestinal obstruction admitted to Shanghai Tenth People's Hospital Affiliated to Tongji University from January 2022 to October 2022. The median age was 53 (42-65) years. Thirty-five of the patients had gynecological tumors and 10 colorectal malignancies. The patients were randomly allocated to a fecal microbiota transplantation group of 20 patients who underwent fecal microbiota transplantation starting 2 weeks before surgery for 6 days, in addition to receiving conventional perioperative treatment, and a conventional treatment group of 25 patients who only received nutritional support during the perioperative period. There were no significant differences in baseline characteristics (sex, age, preoperative nutritional indices, and surgical procedure) between the two groups (all P>0.05). Postoperative recovery (time to passing flatus or a bowel movement, length of stay) and complications were compared between the two groups. Postoperative complications within 30 days after surgery classified in accordance with the international Clavien-Dindo classification of surgical complications (I-V) were statistically analyzed. Improvement in gastrointestinal symptoms, namely abdominal pain, distension, diarrhea, and rectal bleeding) and gastrointestinal quality of life scores (which include 36 problems rated 0-144 points related to physical, psychological, social activities and family life; the lower the score, the more severe the symptoms) were compared between the two groups. Nutritional recovery was assessed by body mass, body mass index, total protein, albumin, prealbumin, and hemoglobin. Results: Compared with the conventional treatment group, the postoperative hospital stay was shorter in the fecal microbiota transplantation group (8.0±4.3 days vs. 11.2±5.4 days, t=2.157, P=0.037) and the time to passage of flatus or having a bowel movement was earlier (2.2±3.2 days vs. 3.9±2.3 days, t=2.072, P=0.044). There were 26 postoperative complications in the fecal microbiota transplantation group and 59 in the conventional treatment group. There were 20 and 36 Grade I to II complications and no and three Grade III to V complications in the transplantation and conventional treatment group, respectively. The overall grade of complication did not differ significantly between the two groups (P=0.544). However, the incidence of postoperative intestinal inflammatory obstruction was lower in the fecal microbiota transplantation than the conventional treatment group (10.0% [2/20] vs. 40.0% [10/25], P=0.040). One patient in the conventional treatment group died. This patient had complete intestinal obstruction complicated by severe malnutrition preoperatively, and an intestinal fistula complicated by abdominal infection postoperatively, and died despite active treatment. Nineteen and 23 patients in the transplantation and conventional treatment group, respectively, attended for follow-up 1 month after surgery; 19 and 21, respectively, attended for follow-up 3 months after surgery, and 17 and 20, respectively, attended for follow-up 6 months after surgery. There were no significant differences between the two groups in abdominal pain or rectal bleeding 1, 3, or 6 months after surgery (all P>0.05). One month after surgery, the incidence of abdominal distension and diarrhea was lower in the fecal microbiota transplantation than in the conventional treatment group (3/19 vs. 48.0% [11/23], P=0.048; 3/19 vs. 52.2% [12/23], P=0.023). However, at the 3 and 6 month follow-ups the incidence of abdominal distension and diarrhea had gradually decreased in both groups and the differences between the groups were not statistically significant (P>0.05 for all). Scores for gastrointestinal quality of life improved significantly in both treatment groups compared with preoperative values (F=71.250, P<0.001; F=79.130, P<0.001, respectively). Scores for gastrointestinal quality of life were higher in the fecal microbiota transplantation than the conventional treatment group at all follow-up time points (P<0.05). One-way ANOVA showed that body mass, body mass index, and total protein, albumin and hemoglobin concentrations improved in both groups compared with preoperative values (all P<0.05). Prealbumin concentration improved significantly in the transplantation (F=5.514, P=0.002), but not in the conventional, group (F=1.535, P=0.211). The improvements in body mass, body mass index, total protein, and albumin were better in the fecal microbiota transplantation than conventional treatment group at 3 and 6 months of follow-up (all P<0.05). Conclusion: Perioperative fecal microbiota transplantation combined with nutritional support is effective in improving early postoperative nutritional status and quality of life in patients with radiation-induced enteritis complicated by intestinal obstruction.目的： 探索围手术期肠道菌群移植联合营养支持治疗对放射性肠炎合并肠梗阻患者术后近期疗效的影响。 方法： 采用前瞻性队列研究方法，前瞻性收集2022年1月至2022年10月间同济大学附属上海第十人民医院收治的45例放射性肠炎合并肠梗阻患者的临床资料，其中男性9例，女性36例；中位年龄53（42~65）岁；妇科肿瘤35例，结直肠恶性肿瘤10例。根据术前与术后是否给予肠道菌群移植治疗，非随机分为肠道菌群移植组（20例，除围手术期常规处理外，术前2周行肠道菌群移植，治疗周期为6 d）与常规治疗组（25例，围手术期仅给予营养支持治疗）。两组患者的基线资料（性别、年龄、术前营养指标、手术方式）比较，差异无统计学意义（均P>0.05）。比较两组患者术后康复（恢复排气排便时间、住院天数）及术后30 d内并发症情况，按照国际通用Clavien-Dindo外科并发症分级体系（Ⅰ~Ⅴ）进行统计。并于术后1、3及6个月进行随访，比较两组胃肠道症状改善情况（包括腹痛、腹胀、腹泻、便血症状）和胃肠生活质量评分（包含涉及生理、心理、社会活动、家庭生活的36个问题，0~144分，分值越低，症状越重），以及营养恢复情况（包括体质量、体质指数、总蛋白、白蛋白、前白蛋白及血红蛋白）。 结果： 与常规治疗组比较，肠道菌群移植组术后住院时间短［（8.0±4.3）d比（11.2±5.4）d，t=2.157，P=0.037］，术后排气排便时间更早［（2.2±3.2）d比（3.9±2.3）d，t=2.072，P=0.044］。两组术后共计26例患者发生59例次并发症；肠道菌群移植组与常规治疗组分别有20例次和36例次Ⅰ~Ⅱ级并发症，0例次和3例次Ⅲ~Ⅴ级并发症，两组总体并发症分级的差异无统计学意义（P=0.544）；但肠道菌群移植组术后小肠炎性梗阻发生率较常规治疗组更低［10.0%（2/20）比40.0%（10/25），P=0.040］。常规治疗组1例死亡，患者术前为完全性肠梗阻合并重度营养不良，术后出现肠瘘并发腹腔感染，经积极治疗无效后死亡。随访至术后1个月时，肠道菌群移植组和常规治疗组获得随访人数分别为19例和23例；术后3个月时，则分别为19例和21例；术后6个月时，则分别为17例和20例。两组患者术后1、3、6个月的腹痛和便血的症状比较，差异均无统计学意义（均P>0.05）。术后1个月时，肠道菌群移植组术后腹胀、腹泻发生率较常规治疗组更低［3/19比48.0%（11/23），P=0.048；3/19比52.2%（12/23），P=0.023］，而随访至3个月及6个月时，两组患者腹胀、腹泻发生率均逐渐降低，组间差异已无统计学意义（均P>0.05）。在胃肠生活质量评分方面，两组均较术前明显提高（常规治疗组：F=71.250，P<0.001；肠道菌群移植组：F=79.130，P<0.001）；在各随访时间点，肠道菌群移植组较常规治疗组评分更高（P<0.05）。单因素方差分析结果显示，两组患者手术治疗前后体质量、体质指数、总蛋白、白蛋白和血红蛋白水平均获得改善（均P<0.05）；肠道菌群移植组患者前白蛋白有改善（F=5.514，P=0.002），而常规治疗组前白蛋白无改善（F=1.535，P=0.211）。且随访至术后3个月及6个月时，肠道菌群移植组的体质量、体质指数、总蛋白和白蛋白改善情况均优于常规治疗组（均P<0.05）。 结论： 围手术期肠道菌群移植联合营养支持治疗可以有效改善放射性肠炎合并肠梗阻患者术后早期营养状况及生活质量。.