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.

abstractsObjective 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.