半肝与全肝入肝血流阻断下肝切除术后肠道细菌易位影响对比研究  

Comparative study on gut barrier dysfunction and bacterial translocation in patients following hepatolobectomy using half liver vascular occlusion with total liver vascular occlusion

作　　者：乔治[1] 李荣[1] 黎沾良[2] 姚咏明[2] 李基业[2] 陆连荣[2] 

机构地区：[1]中国人民解放军总医院普通外科,北京100853 [2]中国人民解放军总医院第一附属医院普通外科,北京100037

出　　处：《中国实用外科杂志》2008年第10期878-879,共2页Chinese Journal of Practical Surgery

基　　金：北京市科技计划项目(No.H020920020530)

摘　　要：目的探讨半肝血流阻断与第一肝门阻断法(Pringle法)对肝叶切除术后肠道细菌易位的影响。方法对2003-2006年中国人民解放军总医院及第一附属医院55例肝叶切除术病人分别选用两种不同阻断血流方法,术前和术后2h、24h、48h采集外周血,应用聚合酶链反应(PCR)方法检测全血细菌DNA,同时行血D-乳酸、内毒素(LPS)浓度检测。结果术前PCR均为阴性,术后共有32例PCR阳性,两组PCR阳性率差异有统计学意义(P<0.01)。全肝阻断组外周血浆D-乳酸及LPS浓度较半肝阻断组明显升高(P<0.01)。结论肝叶切除术中采用半肝血流阻断较全入肝血流阻断肠黏膜屏障受损较轻,肠道细菌易位明显减少。Objective To investigate gut barrier dysfunction and bacterial translocation （BT） after hepatectomy using half or total liver vascular occlusion. Methods Fifty-five patients undergoing selective hepateetomy between 2003 and 2006 at General Hospital of PLA were divided into two groups：half liver occlusion group （HLO） and total liver occlusion group （TLO）. Blood samples were collected prior to and 2h ,24h ,48h after surgery for microbial DNA extraction, plasma D-lactate, LPS measurement. PCR was performed after DNA extraction with target 16S rRNA gene of most pathogenic bacteria. Results No bacterial DNA was detected before surgery, but it was positive in 32 postoperative patients. The PCR- positive rate, plasma levels of D-lactate and endotoxin of TLO were higher than that of HLO （ P 〈0. 01 ）. Conclusion Half liver vascular occlusion has the advantages of both decreasing gut barrier injury and bacterial translocation rate.

关 键 词：半肝血流阻断 第一肝门阻断法 肝叶切除术 肠道细菌易位 

分 类 号：R6[医药卫生—外科学]