乳杆菌对全子宫切除术后阴道微生态的影响

目的 分析甲硝唑阴道准备联合全子宫切除术对患者阴道微生态的影响及乳杆菌的应用价值。 方法 采用前瞻性分析,收集2015年1月至2018年5月我院符合本研究相关标准并行腹腔镜全子宫切除的患者100例为研究对象,患者术前均用甲硝唑进行阴道准备。采用随机数字表将入选患者分为2组,每组50例。观察组患者在术后2个月时采用乳杆菌活菌胶囊阴道给药,1次/d,2粒/次,10 d/疗程,共3个疗程；对照组不处理。观察2组患者术前、术后2个月、术后3个月时阴道乳杆菌数量、pH值、菌群多样性、菌群密集度分级差异,同时对比观察组与对照组患者治疗前后阴道乳杆菌检出率、阴道菌群失衡率、pH值、FSFI分值。 结果 (1)100例患者术后2个月时阴道乳杆菌数量、pH值、菌群多样性、菌群密度分级均显著减少,以Ⅰ级为主；术后3个月时以Ⅳ级为主。(2)与治疗前相比,两组患者阴道乳杆菌检出率均升高,阴道菌群失衡率均降低,pH值均降低,FSFI分值均升高(均P0.05)；治疗后观察组患者阴道乳杆菌检出率高于对照组,阴道菌群失衡率、pH值低于对照组,FSFI分值高于对照组(均P2=3.78,P=0.022)。 结论 甲硝唑阴道准备联合腹腔镜全子宫切除术患者术后阴道微生态环境被破坏,尤其以术后2个月最为明显,给予乳杆菌干预能促使被破坏的阴道微生态环境恢复正常,减少术后细菌性阴道病的发生,值得应用和推广。

Effect of Lactobacillus intervention on vaginal microecology in patients after total hysterectomy

Objective To analyze the effect of vaginal preparation with metronidazole and total hysterectomy on vaginal microecology and the application value of Lactobacillus. Methods One hundred patients who met the inclusion criteria of the study and received laparoscopic hysterectomy from January 2015 to May 2018 were enrolled for prospective analysis. All the patients were treated in our hospital and underwent vaginal preparation with metronidazole before surgery. They were divided into 2 groups randomly with 50 cases in each group. The observation group was treated with Lactobacillus capsules for vaginal administration 2 months after operation, Once a day, 2 capsules a time, 10 days a course of treatment, a total of 3 courses, while the control group was not. The number of vaginal Lactobacillus, pH, and diversity and density of vaginal flora were observed before, 2 months after and 3 months after the surgery. The Lactobacillus detection rate, vaginal flora imbalance rate, pH and FSFI score were compared between the 2 groups before and after treatment. Results (1) The Lactobacillus quantity, pH, and diversity and density of vaginal flora were mainly at level I two months after surgery, and at level IV 3 months after surgery. (2) After treatment, the Lactobacillus detection rate and FSFI score increased, while imbalance rate of vaginal flora and pH value decreased in both groups (all P0.05) but after treatment (all P2=3.78, P=0.022). Conclusion The vaginal microecological environment of patients who received vaginal preparation with metronidazole and laparoscopic total hysterectomy was damaged, especially 2 months after the operation. Lactobacillus intervention can make the damaged vaginal microecological environment return to normal, and reduce postoperative bacterial vaginosis.