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1、中國(guó)醫(yī)師雜志2014年3月第l6卷第3期JournalofChinesePhysician．March2014．v01．16。No．3·333··論著·精準(zhǔn)肝切除對(duì)腸道通透性的影響謝小豐葛建君李介秋陳磊【摘要】目的探討精準(zhǔn)肝切除對(duì)腸道通透性的影響。方法單純行肝切除的患者87例，按入院先后分為(2：1)：精準(zhǔn)組(58例)、對(duì)照組(29例)。精準(zhǔn)組采用精準(zhǔn)肝臟外科技術(shù)行肝切除術(shù)；對(duì)照組采用常規(guī)方法行規(guī)則性肝切除術(shù)。把腹腔滲液作細(xì)菌培養(yǎng)及檢測(cè)腹腔滲液內(nèi)毒素、D乳酸水平來(lái)反映腸通透性變化。結(jié)果精準(zhǔn)組術(shù)后住院時(shí)間、體溫、進(jìn)食及血常規(guī)恢復(fù)正常所需時(shí)間均
2、明顯短于對(duì)照組(tI>7．36，P<0．01)，腹內(nèi)滲液量顯著少于對(duì)照組(t=14．17，P<0．01)。兩組術(shù)中及術(shù)后1d腹腔滲液內(nèi)毒素、D哥L酸水平均顯著高于術(shù)后5d(t≥10．41，P<0．01)。精準(zhǔn)組術(shù)后2d內(nèi)毒素、D·乳酸顯著下降，術(shù)后3d恢復(fù)至正常水平，且術(shù)后2、3d顯著低于對(duì)照組同時(shí)相(tI>9．23，P<0．01)；對(duì)照組從術(shù)后3d才開(kāi)始下降，術(shù)后5d恢復(fù)正常水平。精準(zhǔn)組(5／58)腹腔滲液細(xì)菌培養(yǎng)陽(yáng)性率顯著低于對(duì)照組(13／29)(x=23．51，P<0．01)。結(jié)論精準(zhǔn)肝切除對(duì)腸道通透性的影響相對(duì)較小，患者能較快康復(fù)。
3、[關(guān)鍵詞]肝切除術(shù)；腸／病理生理學(xué)；內(nèi)毒素類(lèi)；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
