左侧结肠创伤一期术后吻合口双管引流对血浆ET和TNF的影响

Effect of Distal Tubes Drainage by Anastomotic Stoma Proximal and on the Levels of Plasmatic Endotoxin and Tumor Necrosis Factor after One-stage Resection of the Traumatic Left Colon

观察经肛吻合口上下双管引流对左侧结肠创伤一期术后血浆内毒素（ET）和肿瘤坏死因子（TNF）水平的影响，间接反映肠黏膜屏障功能的状况，为其在临床上预防吻合口漏的应用提供依据。将左侧结肠创伤一期切除吻合术42例分为术后扩肛组（A组）、经肛吻合口上下双管引流组（B组），观察术后血浆ET及TNF水平的变化。结果显示，术后A、B两组ET、TNF水平均呈下降趋势，均低于术前（P〈0．01），自术后3d，B组ET、TNF水平显著低于A组（P〈0．05）。结果表明，经肛吻合口上下双管引流能有效减少肠道ET的吸收及降低TNF水平，间接反映了该法有利于促进术后肠黏膜屏障功能的恢复。

The objective of the study is to observe the effect of drainage by anastomotic stoma proximal g〉 distal tubes on the levels of plasmatic endotoxin（ET） and tumor necrosis factor（TNF） after one-stage resection of the traumatic left colon,which can indirectly reflect the status of the barrier function of the intestinal mucosa,thus providing reference data in clinical prevention of anastomotic leakage. The 42 cases who underwent one-stage resection and anastomosis were divided into group A （ano-dilation） and group B （drainage by proximal ＆ distal tubes）, and the levels of plasmatic ET and TNF were measured. Results showed that the postoperative levels of ET and TNF in both groups were decreased against the preopera tive figure（ P 〈0.01） ,while since the 3rd day the ET and TNF levels in group B had become much lower than that in group A（ P 〈0.05）. It is concluded that the per-anus drainage by anastomotic stoma proximal and distal tubes is able to effectively reduce ET absorption by intestine and to reduce TNF level, which indirectly reflect that this surgical procedure is able to promote the postoperative recovery of the barrier function of the intestinal mucosa.