大鼠肝切除术时阻断肝门血流对细菌易位的影响

The influence of portal triad clamping on bacterial translocation during liver resection in rats

目的 研究肝切除术时阻断肝门血流对细菌易位和血浆内毒素水平的影响，并探讨其机理。 方法 分别观察了６２ 只大鼠在阻断和不阻断肝门的情况下，肝切除术后６ 小时血中的内毒素含量和细菌易位以及远端回肠组织学变化。 结果 假手术组（ｓｈａｍ ｏｐｅｒａｔｉｏｎ，Ｓｈ 组） 、单纯切肝组（ｈｅｐａｔｅｃｔｏｍｙ，Ｈｔ 组）、阻断切肝组（ｈｅｐａｔｅｃｔｏｍｙ ｕｎｄｅｒ ｐｏｒｔａｌｔｒｉａｄ ｃｌａｍｐｉｎｇ，Ｐｃ＋ Ｈｔ 组） 术后６ 小时腔静脉血、门静脉血的血浆内毒素含量依次升高，分别为０－０２０ ±０－００４、０－０２１±０－００５；０－０２３±０－００６、０－０２６±０－００８ ；０－０２９±０－０１１、０－０３４ ±０－０１２ Ｅｕ／ｍｌ。３ 组术后细菌学结果：Ｓｈ 组２０ 只大鼠术后６ 小时所有标本培养均无细菌生长；Ｈｔ 组２１ 只大鼠术后６ 小时肠系膜淋巴结的细菌易位率为１９％ （４／２１），腔静脉血为１０％ （２／２１），门静脉血为１０％ （２／２１）；Ｐｃ＋ Ｈｔ 组则分别为３８％ （８／２１） 、１９％ （４／２１）、２４％ （５／２１）。在Ｓｈ 组、Ｈｔ 组肠粘膜损伤较轻，而Ｐｃ＋ Ｈｔ 组２１ 只大鼠则损伤明显。

Objective To study the effect of portal triad clamping during liver resection on bacterial translocation and plasma endotoxinic level. Methods Bacterial translocation, the level of plasma endotoxin and morphological alterations of distal small intestine at 6 hours post operation were observed in three groups of sham operation(Sh), 65% hepatectomy(Ht) and 65% hepatectomy under portal triad clamping(Pc+Ht) for 20 minutes. Results The level of plasma endotoxin was increased in the group of the Pc+Ht compared with other two groups, the plasma endotoxin concentration in both vena cava and portal vein was 0 020±0 004,0 021±0 005 Eu/ml in the Sh;0 023±0 006,0 026±0 008 Eu/ml in the Ht;0 029±0 011,0 034±0 012 Eu/ml in the Pc+Ht, respectively. All samples harvested from the Sh were negative for bacterial culture. In the Ht, the incidence of bacterial translocation to the mesenteric lymph nodes,vena cava blood and portal vein blood was 19%(4/21),10%(2/21),10%(2/21),respectively. In the Pc+Ht, the incidence of bacterial translocation was 38%(8/21),19%(4/21),24%(5/21)respectively.The distal small intestine was lightly damaged in the Sh and Ht groups,and significantly damaged in the Pc+Ht group. Conclusion Portal triad clamping can damage the small intestinal mucosa,increase the incidence of bacterial translocation and the level of plasma endotoxin during liver resection.