肝硬化门脉高压症患者行腹腔镜脾切除术对肠源性感染的影响

Influence of total laparoscopic splenectomy on enterogenic infections in cirrhosis and portal hypertension patients

目的探讨全腹腔镜脾切除术对肝炎后肝硬化门脉高压症患者肠源性感染的影响,为临床治疗提供参考依据。方法选择120例肝炎后肝硬化门脉高压症患者为研究对象,将患者随机分为腹腔镜组与开腹手术组,各60例;比较两组患者围手术期内毒素(ET)、肿瘤坏死因子-α(TNF-α)水平和二胺氧化酶(DAO)活性等肠源性感染指标变化。结果腹腔镜组手术时间长于开腹组,但术中失血量、术后引流液量、引流时间、排气时间及住院时间均明显低于开腹组,差异有统计学意义(P<0.05);腹腔镜组肠源性感染率15.0%,明显高于开腹组的3.3%,差异有统计学意义(P<0.05);腹腔镜组术后3、5d血浆DAO活性分别为(1.88±0.28)U/ml、(1.38±0.18)U/ml,明显高于开腹组的(1.40±0.22)U/ml、(0.90±0.19)U/ml,差异有统计学意义(P<0.05);腹腔镜组术后3、5d血浆ET水平分别为(0.38±0.10)EU/L、(0.27±0.09)EU/L,高于开腹组的(0.20±0.09)EU/L、(0.16±0.09)EU/L,差异有统计学意义(P<0.05);腹腔镜组术后3、5d血浆TNF-α水平分别为(2.32±0.38)pg/ml、(1.88±0.28)pg/ml,高于开腹组的(1.60±0.23)pg/ml、(1.49±0.25)pg/ml,差异有统计学意义(P<0.05)。结论全腹腔镜脾切除术对肝炎后肝硬化门脉高压症患者创伤小、恢复快,但增加了肠源性感染的风险,临床中应引起重视。

OBJECTIVE To explore the influence of total laparoscopic splenectomy on enterogenic infections in cirrhosis and portal hypertension patients so as to provide guidance for clinical treatment.METHODS A total of 120 patients with posthepatitic cirrhosis and portal hypertension patients were recruited as the study objects and randomly divided into the laparoscopy group and the laparotomy group,with 60 cases in each group.The changes of the enterogenic infection indicators,such as perioperative endotoxin（ET）,level of tumor necrosis factor-α（TNF-α）,and activity of diamine oxidase（DAO）,were observed and compared between the two groups of patients.RESULTS The operation duration of the laparoscopy group was longer than that of the laparotomy group,however,the intraoperative blood loss volume and postoperative drainage fluid volume were significantly less in the laparoscopy group than in the laparotomy group,and the drainage time,exhaust time,and length of hospital stay were significantly shorter in the laparoscopy group than in the laparotomy group（P〈0.05）.The incidence rate of enterogenic infections of the laparoscopy group was 15.0%,significantly higher than 3.3% of the laparotomy group（P〈0.05）.The plasma DAO activity of the laparoscopy group was（1.88±0.28）U/ml after the surgery for 3days,significantly higher than（1.40±0.22）U/ml of the laparotomy group;the plasma DAO activity of the laparoscopy group was（1.38±0.18）U/ml after the surgery for 5days,significantly higher than（0.90±0.19）U/ml of the laparotomy group（P〈0.05）.The plasma ET level of the laparoscopy group was（0.38±0.10）EU/L after the surgery for 3days,higher than（0.20±0.09）EU/L of the laparotomy group;the plasma ET level of the laparoscopy group was（0.27±0.09）EU/L after the surgery for 5days,higher than（0.16±0.09）EU/L of the laparotomy group（P〈0.05）.The plasma TNF-αlevel of the laparoscopy group was（2.32±0.38）pg/ml after the surgery for 3days,higher than（1.60±0.23）pg/ml of the laparotomy group;the plasma TNF-αlevel of the laparoscopy group was（1.88±0.28）pg/ml after the surgery for 5days,higher than（1.49±0.25）pg/ml of the laparotomy group（P〈0.05）.CONCLUSIONThe total laparoscopic splenectomy has the advantages such as less trauma and rapid recovery for the patients with posthepatitic cirrhosis and portal hypertension,however,it increases the risk of the enterogenic infections,which the hospital should pay attention to.