门静脉高压症全腹腔镜下巨脾切除术后肠源性感染的风险研究  

The risk of intestine-derived infection after totally laparoscopic splenectomy for megalosplenia in the treatment of portal hypertension

作　　者：孙华朋[1] 廖晓锋[1] 张娜[1] 

机构地区：[1]湖北文理学院附属襄阳市中心医院,湖北襄阳441021

出　　处：《腹腔镜外科杂志》2013年第12期889-891,共3页Journal of Laparoscopic Surgery

摘　　要：目的:探讨肝炎后肝硬化门脉高压症患者行全腹腔镜脾切除术后肠源性感染的风险。方法:2009年5月至2013年6月为44例肝炎后肝硬化门静脉高压患者行脾切除术,其中完全腹腔镜手术21例(腹腔镜组,n=21),开腹手术23例(开腹组,n=23)。检测两组患者手术前、后不同时间点外周血内毒素(ET)水平、二胺氧化酶(DAO)活性及肿瘤坏死因子α(TNF-α)浓度。结果:与术前相比,两组患者术后外周血ET、DAO、TNF-α均有所升高(P<0.05)。腹腔镜组术后第3天、第5天血DAO、ET、TNF-α的浓度较开腹组升高明显(P<0.05),然后逐渐下降。结论:肝炎后肝硬化门静脉高压患者行腹腔镜脾切除术,由于存在肝硬化失代偿及腹腔镜手术特殊操作等,可能导致肠壁通透性增高,容易引发肠源性感染。Objective：To evaluate the risk of intestine-derived infection after totally laparoscopic splenectomy in patients of portal hypertension （PHT） with posthepatitic cirrhosis. Methods：Between May 2009 and Jun. 2013,44 patients with PHT and posthepatitic cirrhosis underwent splenectomy. In these patients,21 cases underwent totally laparoscopic splenectomy （laparoscopic group, n = 21 ） , while the other 23 cases underwent conventional open surgery （open group, n = 23 ）. The level of plasma endotoxin （ET） , the activity of serum diamine oxidase （DAO） and the concentration of TNF-α were detected in different time before and after surgery. Resuits ： Compared with preoperative values,levels of serum ET, DAO and TNF-α were increased in both groups （ P 〈 0.05 ）. The level of serum DAO ,ET and TNF-α in the laparoscopic group were significantly higher than those in the open group on the 3rd and the 5th day postoperatively （ P 〈 0.05 ）, then gradually declined. Conclusions ： Because of the deeompensatory cirrhosis and special operating conditions, laparoscopic splenectomy for patients of PHT and posthepatitic cirrhosis may increase the permeability of intestinal wall, and easily trigger intestine-derived infection.

关 键 词：高血压 门静脉 脾切除术 腹腔镜手术 肠源性感染 

分 类 号：R657.6[医药卫生—外科学]