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中华普通外科学文献(电子版) ›› 2026, Vol. 20 ›› Issue (04) : 272 -280. doi: 10.3877/cma.j.issn.1674-0793.2026.04.010

综述

胃肠外科主要术式与肠道微生态重构:机制解析与临床应用
李伟, 胡洁, 王莉娜, 李晓星()   
  1. 510080 广州,中山大学附属第一医院精准医学研究院
  • 收稿日期:2026-05-18 出版日期:2026-08-01
  • 通信作者: 李晓星
  • 基金资助:
    国家自然科学基金面上项目(82372596,82573750)

Principal gastrointestinal surgical procedures and intestinal microecological reconstruction: mechanistic analysis and clinical application

Wei Li, Jie Hu, Lina Wang, Xiaoxing Li()   

  1. Institute of Precision Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
  • Received:2026-05-18 Published:2026-08-01
  • Corresponding author: Xiaoxing Li
引用本文:

李伟, 胡洁, 王莉娜, 李晓星. 胃肠外科主要术式与肠道微生态重构:机制解析与临床应用[J/OL]. 中华普通外科学文献(电子版), 2026, 20(04): 272-280.

Wei Li, Jie Hu, Lina Wang, Xiaoxing Li. Principal gastrointestinal surgical procedures and intestinal microecological reconstruction: mechanistic analysis and clinical application[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2026, 20(04): 272-280.

肠道微生态作为人体“第二基因组”,在维持宿主代谢稳态、免疫功能及肠道屏障完整性中发挥核心作用。胃肠外科手术通过解剖结构重建、消化生理改变及围手术期干预等多种途径,深刻重塑肠道菌群的组成与功能。近年来,随着高通量测序技术、多组学分析和临床转化研究的快速发展,不同胃肠术式对肠道微生态的影响及其与术后并发症的关系逐渐被揭示。本文系统回顾了国内外胃肠外科主要术式,包括减重代谢手术、胃癌根治术、结直肠切除术及回肠造口术等,及其与肠道微生态关系的研究进展,从菌群组成变化、代谢功能重塑、手术并发症的微生态机制及靶向干预策略4个维度进行综述,以期为胃肠外科临床实践提供微生态学视角的循证参考。

As the human body’s “second genome”, intestinal microecology plays a core role in maintaining host metabolic homeostasis, immune function and intestinal barrier integrity. Gastrointestinal surgery profoundly remodels the composition and function of gut microbiota through multiple approaches, including anatomical reconstruction, changes in digestive physiology and perioperative interventions. In recent years, with the rapid advancement of high-throughput sequencing technology, multi-omics analysis and clinical translational research, the effects of different gastrointestinal surgical procedures on intestinal microecology and their correlations with postoperative complications have been gradually clarified. This article systematically reviews domestic and international research progress on the relationship between major gastrointestinal surgical procedures (such as bariatric and metabolic surgery, radical gastrectomy, colorectal resection and ileostomy) and intestinal microecology. The review is conducted from four aspects: alterations in gut microbial composition, remodeling of metabolic functions, microecological mechanisms of surgical complications, and targeted intervention strategies, aiming to provide microecology-based evidence for clinical practice in gastrointestinal surgery.

表1 减重代谢手术后肠道菌群与代谢结局的关联
表2 两种减重术式对肠道微生态影响的差异
表3 胃癌根治术后肠道微生态的主要改变
表4 结直肠术后菌群长期改变与并发症的微生态机制
表5 不同微生态干预策略在胃肠外科中的应用与效果
干预策略 代表菌株/产品 适用术式 干预时机 作用机制 局限性 参考文献
传统益生菌 乳酸杆菌、双歧杆菌 胃癌、结直肠癌术后 术前7 d至术后2~4周 产生细菌素/乳酸抑制致病菌;促进分泌型免疫球蛋白A分泌;上调紧密连接蛋白 菌株特异性差异大,缺乏个体化方案 31,49,50,51
下一代益生菌 A. muciniphila 减重术后、结直肠术后 术后恢复期 降解黏蛋白→丙酸/乙酸↑;TLR2/NLRP3通路调控炎症 巴氏灭活制剂与活菌制剂的优劣未定 52-53
工程化活体药 工程化乳酸乳球菌、大肠杆菌Nissle 1917 围手术期黏膜损伤修复 术后早期 靶向递送IL-10/IL-22等修复因子;纳米抗体中和促炎因子 生物安全(基因水平转移风险)、规模化生产 54
粪菌移植(治疗) 健康供体粪便菌群 术后复发性艰难梭菌感染 感染确诊后 重建正常菌群生态网络,竞争性排除致病菌 供体筛选标准化、长期安全性数据有限 58
粪菌移植(预防AL) 健康供体粪便菌群 结直肠术后AL预防 术前或术后早期 抑制产胶原酶病原体定植与毒力表达 缺乏临床验证,供体-受体匹配标准未定 59-60
膳食纤维 燕麦麸等可溶性纤维 减重代谢术后 术后12周起 促进产SCFAs菌群增殖→GLP-1/PYY↑ 剂量-效应关系未明确,个体差异大 25
后生元 丁酸盐制剂 免疫功能受损患者术后 术后恢复期 为结肠上皮提供能量底物;抑制HDAC调控基因表达 缺乏临床有效性数据,给药途径待优化 61
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