~ < 干硬的粪便压迫直肠壁导致出血甚至穿孔 5 [1] Singh G, Kahler K, Bharathi V, et al. Constipation in adults: complications and comorbidities. Gastroenterology. 2005;128(suppl 2):S960. [2] Eoff JC. Optimal treatment of chronic constipation in managed care: review and roundtable discussion. J Manag Care Pharm. 2008 Nov;14(9 Suppl A):1-15. 便秘显著增加肛肠手术几率 2016年Mayo clinic发表的一项基于3831例样本的流行病学研究; 慢性便秘者中有2%曾行肛肠手术,%做过肛肠手术,比值比(OR)=(95% CI=~,P=) 6 Choung RS, Rey E, Richard Locke G 3rd, et al. Chronic constipation and co-morbidities: A prospective population-based nested case-control study. United European Gastroenterol J. 2016 Feb;4(1):142-51. 便秘导致肠道菌群失调,从而增加手术并发症风险 2016年一项研究,分别对25名健康人(对照组)和25名慢性便秘者的结肠黏膜和粪便微生物进行分析,结果发现: 便秘者肠道菌群构成与对照组有显著差异,拟杆菌丰度显著增加(P<) 7 Parthasarathy G, Chen J, Chen X, et al. Relationship Between Microbiota of the Colonic Mucosa vs Feces and Symptoms, Colonic Transit, and Methane Production in Female Patients With Chronic Constipation. Gastroenterology. 2016 Feb;150(2):367-. 拟杆菌 黏膜拟杆菌丰度 P= 正常结肠传输 慢结肠传输 厚壁菌 粪便细菌丰度 肠道菌群失调增加手术并发症风险 8 Bachmann R, Leonard D, Delzenne N, et al. Novel insight into the role of microbiota in colorectal surgery. Gut. 2017 Apr;66(4):738-749. 对手术伤口愈合有利(+,绿色箭头)和不利(-,红色箭头)的微生物及产物 致病菌过度利用微生物的营养来源和调控信号,促进自身的生长; 明胶酶(GeIE)可破坏肠道的完整性,诱导炎症增加,抑制吻合口生长 影响