胰十二指肠切除术后肠黏膜屏障损伤与肠道细菌移位的临床研究

目的:探讨胰十二指肠切除手术后肠道细菌移位(BT)与术后全身炎症反应综合征(SIRS)关系。方法:40例择期行胰十二指肠切除手术患者,于术前和术后1、3、5天采集外周血,进行血浆D-乳酸,全血细菌DNA检测.全血DNA提取后进行PCR扩增,采用靶基因为大肠杆菌特异性β半乳糖苷酶基因和16SrRNA基因。观察患者术后10天以监测SIRS情况。结果:术前PCR检测全血细菌DNA均为阴性,术后共有13例阳性。术后出现全身炎症反应综合征(SIRS)的患者PCR阳性率为85.7%(12/14),无SIRS组为3.8%(1/26()P<0.01)。PCR阳性组SIRS发生率为93.2%(12/13),阴性组为7.4%(2/27)(P<0.01).PCR阳性的患者外周血血浆D-乳酸浓度较PCR阴性者明显升高(P<0.01),有SIRS的患者外周血血浆D-乳酸浓度较无SIRS患者明显升高(P<0.01)。结论:胰十二指肠切除术后肠黏膜屏障损伤与BT关系密切,术后SIRS和与BT密切相关。PCR技术对术后SIRS有较好的早期预警价值。

Clinical study on gut barrier dysfunction and bacterial translocation inpatients after duodenopancreatectomy surgery

Objective: To investigate the relationship between bacterial translocation and acute systemic inflammatory state (SIRS) in patients who underwent duodenopancreatectomy surgery. Methods: 40 patients who underwent selective duodenopancreatectomy operations were observed. Blood were collected before surgery and 1, 3, 5d after surgery to detect plasma D-lactate and extract DNA.PCR analysis was performed with β -Galactosidase gene of Eschenchia coli and 16SrRNA gene as target gene. The SIRS of all the patients were observed for 10 days. Results: All the PCR results before operation were negative, while there was positive in 13 patients (32.5%,13/40) after duodenopancreatectomy surgery. The positive PCR rate in SIRS was 85.7% (12/14), which was remarkably higher than that without SISR (3.8%, 1/26) (p＜0.01). 92.3% of the patient (12/13) with positive PCR result had SIRS while 7.4% patients (2/27) with negative PCR result did have SIRS (p＜0.01). The plasma levels of D-lactate in patient with positive PCR result was significantly higher than those of the patients with negative PCR result (p＜0.01). The plasma levels of D-lactate in patient with SIRS was significantly higher than those of patients without SIRS (p＜0.01). Conclusion: Increased intestinal permeability had relationship with bacterial translocation and BT was closely related to SIRS after duodenopancreatectomy operations. The positive PCR result might be a useful early warning sign of postoperative SIRS.