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（英文）

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 op-erations 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）（p0.01）.92.3% of the patient（12/13） with positive PCR result had SIRS while 7.4% patients（2/27） with neg-ative PCR result did have SIRS（p0.01）.The plasma levels of D-lactate in patient with positive PCR result was significantly higher than those of the patients with negative PCR result（p0.01）.The plasma levels of D-lactate in patient with SIRS was significantly higher than those of patients without SIRS（p0.01）.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.