慢传输型便秘患者粪菌移植治疗的护理

目的总结30例慢传输型便秘患者行粪菌移植(FMT)治疗的护理方法。方法对30例慢传输型便秘患者行粪菌移植治疗。治疗前做好入院宣教、供体护理、受者肠道准备,配制移植菌液,经鼻肠管注入菌液,移植后密切观察不良反应并做好饮食指导。结果经粪菌移植治疗后第12周,11例(36.7%)患者获得临床治愈,18例(60.0%)获得临床改善,1例无效。患者自主排便次数从治疗前的平均1.2次/周逐渐增加,至12周达4.2次/周。治疗后不同时间点生活质量评分显著低于治疗前(P0.05,P0.01)。结论粪菌移植治疗慢传输型便秘效果良好。在粪菌移植治疗中,供体筛查的准确性、菌液提取与配制、移植前后患者适应性以及移植后肠康复中饮食、活动指导等是护理的重点。     

粪菌移植治疗交替型肠易激综合征的短期疗效和安全性

目的:探讨粪菌移植治疗交替型肠易激综合征(IBS-M)患者的短期疗效和安全性。方法:选取2021年4月至2022年12月,江门市人民医院消化内科收治的IBS-M患者40例,随机分为观察组和对照组,每组各20例。对照组给予双歧杆菌四联活菌治疗,观察组采用粪菌移植治疗。比较2组的短期疗效,包括肠易激综合征严重程度(IBS-SSS)评分、肠易激综合征生活质量(IBS-QOL)评分、胃肠道症状分级(GSRS)评分、肠道菌群多样性(Chao1和Shannon指数)和安全性。结果:与治疗前相比,治疗后8周和3个月的IBS-SSS、GSRS评分均明显降低,IBS-QOL评分升高,且观察组优于对照组(P<0.05)。观察组治疗后Chao1和Shannon指数均高于对照组,且治疗后3个月Chao1和Shannon指数均高于治疗后8周(P<0.05)。2组在安全性评估方面比较,差异无统计学意义(P>0.05)。结论:粪菌移植治疗交替型肠易激综合征患者可提高短期临床疗效,增加肠道菌群的多样性,且安全性良好。     

肠道菌群与肝移植相互作用研究进展

肝移植术后并发症是影响手术成败和患者预后的重要因素,肠道菌群参与人体免疫活化及能量代谢,并与宿主健康疾病状态密切相关。作为肠-肝循环的重要媒介,肠道菌群的稳态将直接影响肝脏系统的结构和功能,并在肝移植患者疾病状态中发挥一定作用。此外,移植手术本身伴随的肠屏障功能减退、免疫功能抑制等又进一步加重致病菌与优势菌比例的失调和菌群移位的发生。基于此,本文系统综述了肝移植患者术前及术后肠道菌群的变化特点,分析菌群变化与肝移植术后并发症的关系,强调恢复菌群结构治疗对于改善移植术前状态、增强受者手术耐受程度以及预防术后并发症发生的重要性。旨在为未来临床肝移植的进一步发展、并发症预防提供参考。     

1例溃疡性结肠炎患者行粪菌移植的护理

对1例溃疡性结肠炎致严重腹泻、菌群失调患者行粪菌移植治疗,移植过程中出现鼻肠管导致的会厌部感染,经对症处理好转。提出做好供体选择、受体肠道准备,供体粪便标本采集、粪悬浮液制备及输注护理等,可提高治疗效果。     

肠菌移植治疗骨质疏松症的研究进展及临床前景

骨质疏松症是临床上常见的骨代谢性疾病,骨折风险高,致残、致死率高.我国正逐步进入老龄化社会,骨质疏松症已经成为影响老年人身体健康的重大公共健康问题.近年来,肠道菌群与骨代谢的关联受到了越来越多的关注,肠道菌群与骨质疏松症之间存在密切关系.肠菌移植是指将肠道菌群从健康的供体转移到肠道菌群失调的受体,其目的是恢复肠道微生物...     

经灌肠途径粪菌移植治疗复杂胆道术后胆瘘继发感染16例

探讨粪菌移植在治疗复杂胆道术后继发感染中的作用。回顾性收集2011年3月—2017年3月西安交通大学医学院附属汉中三二〇一医院收治的16例复杂手术后因胆瘘而继发腹腔感染的患者,均接受粪菌移植治疗。16例患者经灌肠途径粪菌移植后感染状况均得到不同程度的缓解,缓解率达100%,未发现明显的不良反应。粪菌移植在治疗胆道术后胆瘘所引发的术后感染中具有较好的治疗效果。     

肾移植术后反复腹泻患者粪菌移植的护理

回顾性分析2例肾移植术后因反复腹泻接受粪菌移植患者的护理过程,总结供体准备、受体准备、粪菌液制备、粪菌液输注配合、移植后护理、不良反应观察及出院指导等相关经验。本研究2例患者均成功接受粪菌移植,治疗后症状缓解。     

肠道菌群在结直肠癌发生发展和诊断治疗中的作用研究进展

近年来,肠道菌群逐渐成为学科研究热点,大量证据表明肠道菌群失调与多种疾病,特别是结直肠癌（CRC）的发生发展密切相关。菌群失调通过诱导慢性炎症反应、肠上皮DNA损伤、免疫异常及产生肠道菌群代谢产物和细菌酶发挥致癌作用。随着高通量测序技术和宏基因组测序技术的发展,人们对肠道菌群和CRC关系的认识不断突破至新的层面。肠道菌群可作为生物标志物用于CRC的早期诊断与预后判断,并影响免疫治疗和放化疗疗效,同时为CRC的靶向治疗提供大量潜在靶点。笔者就肠道菌群在CRC发生发展、诊断治疗中的作用研究进展进行综述,旨在为临床与基础研究提供参考。     

代谢手术治疗代谢疾病中肠道菌群作用的研究进展

代谢疾病患者肠道微生态与正常人群存在差异.代谢手术治疗代谢疾病疗效确切,而术后肠道菌群发生改变,并趋于正常肠道菌群结构.近年来已发现脂多糖、短链脂肪酸、胆汁酸、胰升血糖素样肽、氧化三甲胺参与代谢手术后病情缓解过程.本文总结了代谢疾病中肠道菌群的特点和代谢手术后肠道菌群的变化,并对这些规律与上述指标关系展开综述.     

肠道菌群移植外科临床应用的争议与共识

肠道菌群移植(FMT)是指将健康人粪便中的功能菌群经一定的方式移植到病人的肠道内,从而调控肠道微生态平衡、重建肠道菌群,达到预防和治疗肠道内外疾病的目的。近年来,FMT治疗病种从复发性难辨梭状芽孢杆菌感染(rCDI)扩展至炎症性肠病(IBD)、肠易激综合征(IBS)、慢性便秘及其他疾病,FMT治疗领域也从内科、儿科延伸到外科。目前有限的临床研究结果显示,外科围手术期应用FMT可能会提高手术病人治愈率,减少术后并发症以及提高术后营养状况和生活质量。但由于FMT在外科领域研究时间尚短,缺乏大样本高质量临床研究,同时,FMT本身方法学较为复杂且存在诸如供体选择、粪便样本标准化处理、FMT移植途径建立等方法学问题仍待完善。因此,对于在外科围手术期应用FMT的具体治疗策略以及疗效尚需要更多更高级别证据加以验证和进一步深入探讨。     

Probiotics and fecal microbiota transplantation in surgical disorders

The importance of the gut microbiota in health and disease has led to interest in developing methods to modify it. Probiotics administration and fecal microbiota transplantation (FMT) are two such approaches that can alter the gut microbiota, potentially offering health benefits by blocking gut colonization by pathogenic organisms and preventing a maladaptive immune response. Both methods have been studied in a variety of settings relevant to colorectal surgeons, including colorectal cancer, inflammatory bowel disease, Clostridium difficile colitis, and surgical site infections. However, both therapies offer risks and benefits in surgical patients. Probiotics allow for targeted alterations of the microbiome, but lingering questions remain regarding strain selection. FMT offers to more completely restore the healthy gut microbial ecosystem but it is difficult to study in animals and to determine its precise mechanism of action. Standardizing study methodologies and using modern molecular and genetic techniques to elucidate the mechanisms of action will be needed to determine the role of probiotic administration and FMT in treating or preventing complications in patients undergoing major abdominal surgery.     

Fecal microbiota transplantation for Clostridium difficile infection: A surgeon׳s perspective

The human gastrointestinal microbiota is composed of a diverse and complex array of bacteria, fungi, and viruses that reside within our gastrointestinal (GI) tract. The microbiota plays a vital role in metabolism, vitamin production, and perhaps most importantly, protection from invasion by pathogenic microorganisms. The modern era of antibiotic use has resulted in unanticipated damage to the microbiota and the disruption of the delicate balance between the microorganisms of which it is composed. Over the last 15 years, there has been an alarming rise in the incidence and severity of Clostridium difficile infection (CDI), with accompanying increases in morbidity and significant mortality. Driven at least in part by the CDI epidemic, fecal microbiota transplantation (FMT) has emerged as an astonishingly effective cure of CDI and has gained widespread acceptance as the treatment of choice for recurrent or relapsing CDI (R-CDI) as well as severe CDI. With the increased practice of FMT in many hospitals, it is pertinent to discuss, from the surgeon׳s perspective, the use of FMT in the various clinical scenarios encountered on the surgical service.     

Fecal microbiota transplantation for the treatment of recurrent and severe Clostridium difficile infection in solid organ transplant recipients: A multicenter experience

Fecal microbiota transplant (FMT) is recommended for Clostridium difficile infection (CDI) treatment; however, use in solid organ transplantation (SOT) patients has theoretical safety concerns. This multicenter, retrospective study evaluated FMT safety, effectiveness, and risk factors for failure in SOT patients. Primary cure and overall cure were defined as resolution of diarrhea or negative C difficile stool test after a single FMT or after subsequent FMT(s) ± anti‐CDI antibiotics, respectively. Ninety‐four SOT patients underwent FMT, 78% for recurrent CDI and 22% for severe or fulminant CDI. FMT‐related adverse events (AE) occurred in 22.3% of cases, mainly comprising self‐limiting conditions including nausea, abdominal pain, and FMT‐related diarrhea. Severe AEs occurred in 3.2% of cases, with no FMT‐related bacteremia. After FMT, 25% of patients with underlying inflammatory bowel disease had worsening disease activity, while 14% of cytomegalovirus‐seropositive patients had reactivation. At 3 months, primary cure was 58.7%, while overall cure was 91.3%. Predictors of failing a single FMT included inpatient status, severe and fulminant CDI, presence of pseudomembranous colitis, and use of non‐CDI antibiotics at the time of FMT. These data suggest FMT is safe in SOT patients. However, repeated FMT(s) or additional antibiotics may be needed to optimize rates of cure with FMT.     

Alleviation of refractory IgA nephropathy by intensive fecal microbiota transplantation: the first case reports

BackgroundGut dysbiosis may be implicated in the pathogenesis of IgA nephropathy (IgAN) through immune and/or metabolite pathways. Fecal microbiota transplantation (FMT) could reestablish the micro-ecological balance in IgAN, although this has never been attempted before. We explored whether FMT could be efficacious in treating IgAN in two patients with refractory IgAN.Case presentationTwo Chinese female patients with IgAN failed to achieve clinical remission after receiving several rounds of immunosuppressive therapy and suffered from unbearable adverse effects due to immunosuppressants. Both patients received intensive fresh FMT conducted through transendoscopic enteral tubing (TET) regularly for 6–7 months, and were followed up for a further 6 months. Partial clinical remission was achieved in both patients, evidenced by a decrease in the 24-h urinary protein (24-hUP) to less than half of baseline during FMT treatment or follow-up, along with increased serum albumin (sAlb) and stable kidney function. The gut microbiota of both patients was distorted with lower biodiversity and altered composition, which was reversed following FMT. Phylum Proteobacteria decreased while genus Prevotella increased during and after FMT. The intensive fresh FMT was well-tolerated, and no severe adverse events occurred.ConclusionsPreliminary evidence of the safety and efficacy of FMT for treating refractory IgAN may provide a new direction by which to decipher the pathogenesis of IgAN.     

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??Fecal microbiota transplantation for treatment of slow transit constipation: A clinical study of 20 patients TIAN Hong-liang??DING Chao??GONG Jian-feng??et al. Department of General Surgery??Jinling Hospital??Medical School of Nanjing University??Nanjing 210002?? China
Corresponding author??LI Ning??E-mail: liningrigsnju@163.com
Abstract Objective To examine the safety and efficacy of fecal microbiota transplantation (FMT) for slow transit constipation (STC). Methods Twenty patients with STC were enrolled in the prospective open-label study. All the patients were performed FMT. Autonomous defecation frequency??Wexner constipation scale, bowel movement and related adverse reaction per week around FMT were evaluated at each study visit. All the patients were followed up for 8 weeks. Results Compared with pre-FMT treatment??the patient’s stool frequency increased significantly ??(1.5 ± 1.3) times/week vs. (4.5±1.5) times/week?? after eight weeks of treatment. Meanwhile??Wexner constipation scores demonstrated a significant reduction ??(15.7 ± 3.5) vs. (7.5 ± 1.6)?? and GIQLI score increased remarkably??(84.6 ± 12.5) vs. (116.6 ± 11.5)??, which has significant difference statistically (P<0.05). There were 12 patients obtained clinical improvement and seven patients obtained clinical remission till to 8 weeks. FMT efficacy was stable and no serious adverse event occurred during the whole follow-up. Conclusion FMT is safe and effective for treating slow transit constipation and the short-term treatment effect is good.     

The protective effects of fecal microbiota transplantation in an experimental model of necrotizing enterocolitis

BackgroundNecrotizing enterocolitis (NEC) is a serious disease that affects premature neonates, causing high mortality. In the search for new options of treatment it was investigated whether fecal microbiota transplantation (FMT) decreased the inflammatory response during NEC development in experimental model.MethodsWistar rats were used and divided as follows: naïve, control (NEC induction), FMT-before (transplantation of microbiota before insult) and FMT-after (microbiota transplantation after insult). The microbiota transplantation was performed by administering a feces solution obtained from an adult donor rat. The induction of enterocolitis involves feeding by artificial formula, hypothermia, hypoxia and endotoxin administration. MPO activity, TNF-α, IL-1β and IL-6 levels, oxidative and nitrosative damage and the grade of intestinal mucosa lesion were analyzed.ResultsThe control group had a significant increase of inflammatory and oxidative parameters when compared to naive animals. Both FMT-before and after decreased all inflammatory and oxidative damage parameters when compared to control group. This was also true to the intestinal mucosa damage.ConclusionFMT administered just before or after NEC induction improved gut and systemic inflammation, and gut oxidative damage and intestinal injury.     

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??Capsulized fecal microbiota transplantation for the treatment of slow transit constipation: A therapeutic analysis of 15 cases TIAN Hong-liang, DING Chao, MA Chun-lian, et al. Department of General Surgery??Jinling Hospital??Medical School of Nanjing University??Nanjing 210002??China
Corresponding author??LI Ning??E-mail: liningrigsnju@163.com
Abstract Objective To evaluate the efficacy and safety of capsulized fecal microbiota transplantation (FMT) for slow-transit constipation (STC). Methods A total of 15 patients with STC in Jinling Hospital, Medical School of Nanjing University were enrolled in the study,who received capsulized FMT for 3 days, and followed up for 12 weeks after treatment. Rate of clinical remission, Bristol Stool Form Scale, Wexner constipation scale, and bowel movement per week were evaluated at each study visit. Results Compared with pre-FMT treatment, the rate of clinical cure and remission based on clinical activity at week 12 was 40% (6/15) and 53.3% (8/15) , respectively. The patients’stool frequency increased significantly [(2.2 ± 1.5) times/week vs. (3.1 ± 2.1) times/week] after 12 weeks of treatment. Meanwhile, Bristol scale [(6.7±1.3) vs. (5.1±1.8)], Wexner constipation scores demonstrated a significant reduction [(13.7 ± 3.5) vs. (10.1 ± 2.3)] and GIQLI score increased remarkably [(87.2 ± 14.6) vs. (110.9 ± 10.5)]. Those differences were significant statistically (P??0.05). Capsulized FMT efficacy was stable and no serious adverse events occurred during the whole follow-up. Conclusion Capsulized FMT is safe and effective for the treatment of STC, and short-term treatment effect is good.     

粪菌移植治疗慢传输型便秘20例临床研究

目的 探讨粪菌移植（FMT）治疗慢传输型便秘的有效性和安全性。方法 选择2014年12月至2015年2月南京大学医学院附属金陵医院收治的20例明确有慢传输因素的慢性便秘病人,所有病人均行FMT治疗,记录移植治疗前后病人每周自主排便次数、Wexner便秘评分、胃肠生活质量及相关不良反应。治疗后随访8周。
结果 与治疗前比较,FMT治疗后第8周病人排便次数明显增加［（1.5±1.3） vs. （4.5±1.5）次/周］,Wexner便秘评分明显下降［（15.7±3.5） vs. （7.5±1.6）分］,GIQLI评分升高［（84.6±12.5） vs. （116.6±11.5）分］,差异均有统计学意义（P<0.05）。随访期间疗效稳定,至第8周共12例病人获得临床改善,7例病人获得临床治愈。临床改善所需时间为（10.9±4.9）d。随访期间均未发生严重不良反应。结论 FMT治疗慢传输型便秘安全、有效,短期治疗效果良好。