妇科腹腔镜手术前后肠道黏膜通透性和炎症因子的改变

Effects of gynecological laparoscopic surgery on intestinal mucosal epithelial permeability and inflammatory factors

目的观察妇科腹腔镜手术前后肠道黏膜上皮通透性和炎症因子的变化,以明确妇科微创手术对患者生理功能的影响。方法选择2021年8月至2021年10月在福建中医药大学附属人民医院妇科拟行妇科腹腔镜手术的住院患者30例。腹腔镜手术采用二氧化碳人工气腹,分别在术前1d、术后24h、72h,抽取患者静脉血,检测血浆D-乳酸和二胺氧化酶(diamineoxidase,DAO)水平,血浆白介素1(interleukin1,IL-1)、白介素6(interleukin6,IL-6)、肿瘤坏死因子-α(tumornecrosisfactor-α,TNF-α)水平,比较手术前后指标的变化。结果术后24h患者血浆D-乳酸[(3.24±0.68)mmol/L]和DAO水平[(6.63±1.35)μg/L]与术前1d[D-乳酸:(2.64±0.70)mmol/L,DAO:(5.50±1.52)μg/L]比较明显升高,差异有统计学意义(P<0.05)。术后24h患者血浆炎症因子水平[IL-1(350.95±80.33)ng/L,IL-6(119.92±31.44)ng/L,TNF-α(57.37±12.93)ng/L]与术前1 d[I L-1(291.23±90.36)ng/L,I L-6:(96.24±31.49)ng/L,TNF-α:(46.40±14.93)ng/L]比较明显升高,差异有统计学意义(P<0.05)。结论妇科腹腔镜手术后肠道黏膜通透性增加,血浆炎症因子增高,可能导致术后肠功能紊乱,影响患者术后快速康复。临床上应重视开展减轻肠道屏障功能损伤,降低炎症反应方面的相关研究。

Objective To observe the changes of intestinal mucosal permeability and inflammatory factors before and after gynecological laparoscopic surgery.Method Thirty inpatients who underwent gynecological laparoscopic surgery using carbon dioxide artificial pneumoperitoneum were selected.Venous blood samples were collected from patients 1 day before surgery,24 hours after surgery,and 72 hours after surgery,respectively,to measure plasma D-lactic acid and diamine oxidase(DAO)concentrations,as well as plasma IL-1,IL-6,TNF-αconcentrations.The changes of indicators before and after surgery were compared.Result Plasma levels of D-lactic acid and DAO were significantly higher at 24 hours after surgery[(3.24±0.68)mmol/L and(6.63±1.35)μg/L,respectively]than those at 1 day before surgery[(2.64±0.70)mmol/L and(5.50±1.52)μg/L,respectively](P<0.05).There was no significant difference between plasma levels of D-lactic acid and DAO at 72 hours after operation[(2.91±0.72)mmol/L and(6.13±1.46)μg/L,respectively]and those at 1 day before operation(P>0.05).Plasma levels of IL-1,IL-6 and TNF-αwere significantly higher at 24 hours after surgery[(350.95±80.33)ng/L,(119.92±31.44)ng/L,and(57.37±12.93)ng/L,respectively]than those at 1 day before surgery[(291.23±90.36)ng/L,(96.24±31.49)ng/L,and(46.40±14.93)ng/L,respectively](P<0.05).There was no significant difference between plasma levels of IL-1,IL-6 and TNF-αat 72 hours after operation[(38.92±83.98)ng/L,(110.13±29.78)ng/L,and(52.45±13.70)ng/L,respectively]and those at 1day before operation(P>0.05).Conclusion Gynecological laparoscopic surgery increased intestinal mucosal permeability and plasma inflammatory factors,which may impair postoperative intestinal function and recovery.This suggests the need for more research on reducing intestinal barrier damage and inflammation.