CAJ | 학술논문

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明显短于对照组(t ≥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-乳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(t≥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)(x2=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.
목적 탐토정준간절제대장도통투성적영향.방법 단순행간절제적환자87례,안입원선후분위(2∶1):정준조(58례)、대조조(29례).정준조채용정준간장외과기술행간절제술；대조조채용상규방법행규칙성간절제술.파복강삼액작세균배양급검측복강삼액내독소、D-유산수평래반영장통투성변화.결과 정준조술후주원시간、체온、진식급혈상규회복정상소수시간균명현단우대조조(t ≥7.36,P＜0.01),복내삼액량현저소우대조조(t=14.17,P＜0.01).량조술중급술후1d복강삼액내독소、D-유산수평균현저고우술후5d(t≥10.41,P＜0.01).정준조술후2d내독소、D-유산현저하강,술후3d회복지정상수평,차술후2、3d현저저우대조조동시상(t≥9.23,P＜0.01)；대조조종술후3d재개시하강,술후5d회복정상수평.정준조(5/58)복강삼액세균배양양성솔현저저우대조조(13/29)(x2=23.51,P＜0.01).결론 정준간절제대장도통투성적영향상대교소,환자능교쾌강복.
Objective To evaluate the influence of precise liver resection techniques on intestinal permeability in the diseases needing liver resection.Methods Eighty-seven patients needing liver resection were randomized to receive the precise liver resection (n =58,PLR group) or the conventional liver resection (n =29,CLR group).D-lactate and and endotoxin in abdominal fluid were detected in all the patients.The abdominal fluid bacteria cultures were performed.Results The postoperative hospitalization time,the needed time of blood routine,temperature,and oppetite resuming were significantly shorter in PLR group than those in CLR group (t ≥7.36,P ＜ 0.01) ; The postoperative abdominal effusion was significantly less in PLR group than that of CLR group(t ≥ 14.17,P ＜0.01).The abdominal fluid concentrations of D-lactate and endotoxin in operation or at 1d after operation were significantly higher than those at 5d after operation in both groups(t ≥10.41,P ＜0.01).Those parameters decreased significantly at 2d after operation,returned to the normal level at 3d after operation in PLR group,and those parameters were significantly lower in PLR group than those in CLR group at the same time phase after postoperative 2 or 3 days (t ≥9.23,P ＜0.01) ; Those parameters began to drop at 3d after operation,returned to the normal level at 5d after operation in CLR group.The positive rate of abdominal fluid bacteria cultures was significantly lower in PLR group than that in CLR group(13/29) (x2 =23.51,P ＜ 0.01).Conclusions The precise liver resection techniques had an important influence on intestinal permeability in the diseases needing liver resection.