全腹腔镜脾切除加贲门周围血管离断术后肠源性感染指标的变化  

Intestine-derived infection indexes changes after total laparoscopic splenectomy combined with pericardial devascularization(LSPD) in treatment of portal hypertension

作　　者：孙华朋[1] 廖晓锋[1] 张娜 Hua-peng Sun;Xiao-feng Liao;Na Zhang(Department of General Surgery,Xiangyang Central Hospital,Hubei College of Liberal Arts and Sciences,Xiangyang,Hubei 441021,China;Department of Pathology,Xiangyang Central Hospital,Hubei College of Liberal Arts and Sciences,Xiangyang,Hubei 441021,China)

机构地区：[1]湖北省襄阳市中心医院(湖北文理学院附属医院)普外科,湖北襄阳441021 [2]湖北省襄阳市中心医院(湖北文理学院附属医院)病理科,湖北襄阳441021

出　　处：《中国内镜杂志》2018年第11期78-83,共6页China Journal of Endoscopy

摘　　要：目的探讨全腹腔镜贲门周围血管离断术对肝炎后肝硬化门静脉高压症肠源性感染的影响。方法 2015年9月-2017年3月对36例肝炎后肝硬化门静脉高压症患者行腹腔镜贲门周围血管离断术。其中,全腹腔镜17例(腹腔镜组,n=17),开腹手术19例(开腹组,n=19)。观察两组临床指标,并于手术当天早晨及术后3、6和9 d抽外周血,检验内毒素(ET)水平、二胺氧化酶(DAO)活性及肿瘤坏死因子α(TNF-α)浓度。结果与术前比较,腹腔镜组术后肠源性感染5例,开腹组2例,差异无统计学意义(P>0.05)。两组术后3和6 d DAO、ET和TNF-α水平较术前升高(P <0.05)。腹腔镜组术后3和6 d外周血DAO、ET和TNF-α与开腹组比较升高明显(P <0.05)。结论肝炎后肝硬化门静脉高压症患者行腹腔镜贲门周围血管离断术,由于受肝硬化及腹腔镜气腹等影响,可导致患者肠壁通透性增高,从而增加肠源性感染的风险。Objective To evaluate the impact of intestine-derived infection after total laparoscopic splenectomy combined with pericardial devascularization(LSPD)in treatment of portal hypertension(PHT)with post-hepatitis hepatic cirrhosis.Methods 36 patients with PHT with post-hepatitis hepatic cirrhosis,who received splenectomy combined with pericardial devascularization.17 patients underwent total laparoscopic splenectomy combined with pericardial devascularization(laparoscopic group,n=17)and 19 such patients undergoing conventional open surgery(open group,n=19)from September 2015 to March 2017 were analyzed.The levels of serum diamine oxidase(DAO),plasma endotoxi(ET),TNF-αon the day 0,3,6,9 after treatment were determined.Before and after operation,and between the two groups in different time in patients with peripheral blood ET,DAO,TNF-a concentrations were compared.Results After the treatment,the intestine-derived infection in laparoscopic group is 5 cases,which in open group is 2 cases(P>0.05).The levels of serum DAO,ET,TNF-αwere increased in both groups(P<0.05).The levels of serum DAO,ET,TNF-αin the laparoscopic group were significantly higher than those in the open group on the 3,6 day(P<0.05).Conclusions The patients of portal hypertension with post-hepatitis hepatic cirrhosis after total LSPD,in which carbon dioxide pneumoperitoneum may increase the risk of intestinal barrier dysfunction,even may cause intestine-derived infection.

关 键 词：腹腔镜手术 门静脉高压症 肠源性感染 

分 类 号：R657.34[医药卫生—外科学]