小肠移植与肠道细菌移位

Small Bowel Transplantation and Bacterial Translocation

目的 探讨小肠移植后肠道细菌移位的原因和防治方法。方法 综述小肠移植与肠道细菌移位的相关文献。结果 移植小肠缺血再灌注损伤 ,免疫排斥反应 ,移植物抗宿主病和免疫抑制剂的应用都会导致肠粘膜屏障功能损害 ,肠蠕动和运输功能紊乱 ,肠道内条件致病菌过度生长 ,细菌和毒素向肠外组织器官移位 ,引起受体感染。结论 小肠移植后肠道细菌移位的发生率较高 ,是引起受体感染 ,影响预后的一个主要因素。提高肠移植外科技能 ,缩短缺血保存时间 ,选择性肠道去污 ,改进营养支持和免疫抑制方案 ,有望减少肠移植后细菌移位 ,降低感染并发症 ,提高预后指标。

Objective To discuss the cause and prevention of bacterial translocation after small bowel transplantation (SBT). Methods Most of the existing literatures concerning bacterial translocation and SBT were reviewed. Results The ischemia/reperfusion injury, graft rejection, graft versus host disease (GVHD) and administration of immunosuppressive drugs were associated with the gut barrier damage, intestinal mobility and transmit dysfunction and luminal potentially pathogenic bacterial overgrowth after SBT which caused the germs and toxin to translocate into recipient tissues, and posed a major threat on the development of sepsis. Conclusion The rate of bacterial translocation after SBT is higher than that of other types of solid organ transplantation,which is the main cause of recipient sepsis affecting the outcome of SBT. Improving the surgical techniques, shortening ischemia preservation time, selective bowel decontamination and improving the methods of nutritional support and immunosuppression would decrease the incidence of bacterial translocation and sepsis, and improve the outcome of SBT.