脾切除对肝大部分切除术后细菌移位的影响

Effect of splenectomy on bacterial translocation after major liver resection in rats

目的观察脾切除对大鼠肝大部分切除术后细菌移位的影响。方法将SD大鼠随机分为3组：假手术组（SO组），2／3肝切除组（PHx组），肝切除加脾切除组（PHx＋sp组）。85只大鼠中30只用于测定门静脉压力，55只用于分析细菌移位、血浆内毒素、血浆D-乳酸、肠组织病理学及免疫功能。结果PHx组门静脉压力（13．34±0．64）cmH2O（1cmH：0=0．098kPa）显著高于SO组（7．64±0．44）cmH：0和PHx＋Sp组（10．30±0．69）cmH：0（P〈0．01）。PHx组的细菌移位率高于SO组（65．00％比6．67％；P〈0．01），也明显高于PHX＋sp组（25．00％；P〈0．05）。大鼠血浆内毒素中位数SO组为0．00ng／L，PHx组为4．05ng／L，PHx＋sp组为1．47ng／L（P〈0．01）。血浆D．乳酸在s0组和PHx＋Sp组也较PHX组低（分别为1．68、23．36、39．09g／L，P〈0．01）。结论脾切除能降低肝大部分切除大鼠门静脉压力，增强肠黏膜屏障功能，减少内毒素和细菌移位的发生。

Objective To investigate the effects of splenectomy on bacterial tranlocation after ma- jor liver resection. Methods Rats were divided into three groups ： the sham operation group （ SO group）, the two-thirds partial hepatectomy group （PHx group） and the two-thirds partial hepatectomy plus splenec- tomy group （PHx ＋ Sp group）. Portal pressure was measured in 30 rats, and BT, endotoxemia, intestinal permeability to D-lactic acid, intestinal histology and immune function were analyzed in 55 rats. Results Portal pressure in the PHx rats [ （ 13. 34 ＋0.64） cm H20 （ 1 cm H20 =0. 098 kPa） ,P 〈0. 01 ] was sig- nificantly higher than in the SO rats （7.64~ 0.44） emH20 and the PHx ＋ Sp rats （10.30~ 0. 69） em H20. In addition, the rate of BT was higher in the PHx rats than in the SO rats （65.00% vs 6. 67% ;P 〈0. 01 ）. Splenectomy significantly reduced BT in the PHx rats （25.00% ;P 〈0. 05）. Endotox- emia was not evident in the SO rats （0. 00 ng/L） and blood endotoxin levels were decreased in the PHx ＋ Sp rats （1.47 ng/L） as compared with the PHx rats （4. 05 ng/L,P 〈0. 01 ）. D-lactic acid level was also higher in both the PHx and PHx ＋ Sp rats than in the SO rats （39. 09, 23.36, and 1.68 g/L respectively; P 〈 0. 01 ）. Conclusion Splenectomy induced improvement in the intestinal histology, lowered portal pres- sure, enhanced intestinal barrier function and diminished blood endotoxin levels and BT in rats with major liver resection. Spleneetomy might be useful in the prevention of infection after major liver resection.