脾肾分流术对门静脉高压症肠道菌群失调、细菌移位的保护作用

Effects of the Splenorenal Shunt on the Intestinal Flora Imbalance and Intestinal Bacterial Translocation in Patients with Cirrhotic Portal Hypertension

目的探讨脾肾分流术对门静脉高压症肠道菌群失调、细菌移位的保护作用。方法将75例门静脉高压症患者(均有食道胃底静脉曲张破裂出血病史)分为脾肾分流组(50例)和断流组(25例),分别行脾肾分流及断流术,术后对腹腔渗液计量并作细菌培养及炎性介质的检测;在无菌操作下采集两组病人术后1 d、 3 d、 5 d、 7 d的肠内容物标本分别行需氧、厌氧菌培养并计数;评估术后15 d消化道症状。结果分流组术后15 d消化道症状如腹胀、食欲不振、便秘、腹泻明显改善(P<0.05)。分流组腹腔渗液明显少于断流组(P<0.05),且渗液细菌培养阳性率(12%,6/50)显著低于断流组(44%,11/25)(P<0.05),炎性介质浓度明显低于断流组(P<0.05)。两组术后1 d存在明显的肠道菌群失调(P<0.05),分流组术后3 d起肠道主要优势菌群(双歧杆菌和乳酸杆菌)增殖,病原菌(大肠杆菌和肠球菌)被抑制;断流组术后7 d才恢复正常水平,且分流组术后3 d、 5 d明显优于断流组术后同时期(P<0.05)。结论脾肾分流术能适当降低门静脉压,减轻胃肠血流淤滞,对门静脉高压症肠道菌群失调、细菌移位有明显的保护作用。

Objective To investigate the effects of the splenorenal shunt(SRS) on the intestinal flora imbalance and intestinal bacterial translocation in patients with cirrhotic portal hypertension. Methods 75 patients with hemorrhagic esophageal varices secondary to cirrhotic portal hypertension were divided into the SRS group and the esophogeogastric devascularizatiom(EGD)group retrospectively. The 15-day postoperative digestive symptom relief was invested. And bacteria culture and inflammatory mediators such as procalcitonin(PCT), tumor necrosis factor(TNF-α) and interleukin 6( IL-6) level of the abdominal fluid were studied. Results In the SRS group, the digestive symptoms such as abdominal distension, anorexia, constipation and diarrhea were significantly relieved 15 days after operation. The positive rate of bacterial culture in peritoneal exudate(12%, 6/50) were significantly lower than that of the EGD group(44%, 11/25)(P<0.05). And the concentration of inflammatory medium in peritoneal exudate of the SRS was lower than of the EGD group(P<0.05). There was significant intestinal flora imbalance in the two groups on the first day after operation(P<0.05). In the SRS group, the dominant intestinal flora(Bifidobacterium and Lactobacillus) proliferated and the pathogenic bacteria(Escherichia coli and Enterococcus) were inhibited on the third day after operation. The EGD group returned to normal level 7 days after operation, and the SRS group was significantly better than the SRS group at the same time(P<0.05). Conclusion The SRS may improve the intestinal flora imbalance by inhibition of bacterial translocation in patients with cirrhotic portal hypertension.