严重腹部创伤休克时肠损伤后不同手术方式对肠黏膜屏障的影响

The effect of different surgery managements on intestinal mucosal barrier with severity abdominal trauma and shock

目的:对照研究严重腹部创伤休克时肠道损伤后不同手术方法对术后肠黏膜屏障的影响。方法:雌性杂种猪麻醉后,建立多发肠管损伤并发酸中毒、低体温、凝血障碍"致死三联征"的严重腹部创伤实验模型,随机分为三组,每组7只。即①对照组:手术修补(修补)组行肠管损伤修补吻合术,7号线双层关闭腹腔;②肠道结扎(结扎)组行肠管损伤段丝线结扎;③肠道造口(造口)组行损伤段肠道内置入肛管,荷包缝合固定后,经切口旁引出。监测术后0、6、12和24 h二胺氧化酶(DAO)活力。术后24 h行门静脉和外周血细菌培养,观察空肠和末端回肠黏膜屏障组织变化。结果:DAO活力造口组较结扎组和修补组低,门静脉和外周血细菌培养阳性率亦低。病理学观察结扎组肠黏膜组织损伤最重,修补组次之,造口组损伤最轻。结论:肠道造口符合损伤控制手术要求,优于肠道结扎和传统手术,能避免进一步加重肠黏膜屏障破坏,减轻细菌易位和全身炎症反应的发生。

Objective： To compare the effects of damage control surgery management of ligation and Ostomy and traditional anastomosis following serious abdominal trauma on intestinal mucosal barrier.Methods： After the model establishment of bowel injury associated with ＂lethal triad＂ in serious abdominal trauma,female domestic pigs were randomly divided into three groups（n=7/per group）： intestinal anastomosis group,intestinal ligation group,and intestinal drainage groups.DAO,portal vein and peripheral vein bacterial cultures,small intestine conventional H-E staining and transmission electron microscope（TEM）examination were observed.Results： Positive rate of bacterial culture and DAO of IL group were significantly increased.Pathological injuries were significantly lower in the ID group than that of IL and IA groups.Conclusion： Compared with traditional surgery,damage control surgery（IL group and ID group） can shorten operation time.Compared with others,ID groups can avoid increasing further injuries,intestinal mucosal barrier injury and systemic inflammatory response.