精准肝切除对肠道通透性的影响.pdf

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1、中国医师杂志2014年3月第l6卷第3期JournalofChinesePhysician．March2014．v01．16。No．3·333··论著·精准肝切除对肠道通透性的影响谢小丰葛建君李介秋陈磊【摘要】目的探讨精准肝切除对肠道通透性的影响。方法单纯行肝切除的患者87例，按入院先后分为(2：1)：精准组(58例)、对照组(29例)。精准组采用精准肝脏外科技术行肝切除术；对照组采用常规方法行规则性肝切除术。把腹腔渗液作细菌培养及检测腹腔渗液内毒素、D乳酸水平来反映肠通透性变化。结果精准组术后住院时间、体温、进食及血常规恢复正常所需时间均

2、明显短于对照组(tI>7．36，P<0．01)，腹内渗液量显著少于对照组(t=14．17，P<0．01)。两组术中及术后1d腹腔渗液内毒素、D哥L酸水平均显著高于术后5d(t≥10．41，P<0．01)。精准组术后2d内毒素、D·乳酸显著下降，术后3d恢复至正常水平，且术后2、3d显著低于对照组同时相(tI>9．23，P<0．01)；对照组从术后3d才开始下降，术后5d恢复正常水平。精准组(5／58)腹腔渗液细菌培养阳性率显著低于对照组(13／29)(x=23．51，P<0．01)。结论精准肝切除对肠道通透性的影响相对较小，患者能较快康复。

3、[关键词]肝切除术；肠／病理生理学；内毒素类；乳酸．TheinfluenceofpreciseliverresectiontechniquesOllintestinalpermeabilityinthediseasesneedingliverresectionXieXiaofeng，GeJianjun，LiJieqiu，ChengLei．DepartmentofGeneralSurgery，163HospitalofPeopledLiberationArmy(P)，Changsha410003，China【Abstract】Objectiv

4、eToevaluatetheinfluenceofpreciseliverresectiontechniquesonintestinalpermeabilityinthediseasesneedingliverresection．MethodsEighty—sevenpatientsneedingliverresectionwererandomizedtoreceivethepreciseliverresection(n=58，PLRgroup)ortheconventionalliverresection(n=29，CLRgroup)．D

5、-lactateandandendotoxininabdominalfluidweredetectedinallthepatients．Theabdominalfluidbacteriacultureswereperformed．ResultsThepostoperativehospitalizationtime，theneededtimeofbloodroutine，temperature，andoppetiteresumingweresignificantlyshorterinPLRgroupthanthoseinCLRgroup(t≥

6、7．36，P<0．01)；ThepostoperativeabdominalefusionwassignificantlylessinPLRgroupthanthatofCLRgroup(t≥14．17，P<0．O1)．TheabdominalfluidconcentrationsofD-lactateandendotoxininoperationoratldafteroperationweresignificantlyhigherthanthoseat5dafteroperationinbothgroups(t≥10．41，P<0．01)

7、．Thoseparametersdecreasedsignificantlyat2dafteroperation，re—turnedtothenormallevelat3dafteroperationinPLRgroup，andthoseparametersweresignificantlylowerinPLRgroupthanthoseinCLRgroupatthesametimephaseafterpostoperative2or3days(tI>9．23，P<0．01)；Thoseparametersbegantodropat3daf

8、teroperation，returnedtothenormallevelat5dafteroperationinCLRgroup．Thepositiverateofabdomi