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

摘要： 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。
Abstract: 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-α on 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-α were increased in both groups (P < 0.05). The levels of serum DAO, ET, TNF-α in 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.