TIPS术及门奇静脉断流术对全身炎症反应及肠道生物屏障的影响

发布时间：2018-04-08 14:07

本文选题：经颈内静脉门体分流术　切入点：门奇断流术　出处：《南京大学》2015年硕士论文

【摘要】：目的:通过观察经颈内静脉肝内门体分流术(TIPS)及门奇断流术对肝硬化门脉高压症患者炎性介质、细胞因子及肠道菌群的影响,探讨两种手术方式对于全身炎症反应及肠道生物屏障影响的差异性。方法:对22例因门脉高压症行TIPS患者和10例行门奇断流术患者,用ELISA法、硝酸氮还原法和硫代巴比妥酸法分别测定术前及术后一周的门静脉、肝静脉及下腔静脉中TNF-α,IL-1β,IL-6,NO和MDA水平。应用梯度变性凝胶电泳法测定术前及术后一月肠道菌群的变化。结果:TIPS组和断流术组术后门静脉压力均有显著降低(P0.05)。TIPS组炎症介质及MDA在术后未见明显变化(P0.05)。断流术组炎症介质及MDA在术后明显升高(P0.05)。TIPS组和断流术组NO水平在门静脉和肝静脉处明显降低(P0.05),肠道菌群量较术前也显著减少(P0.05)。结论:TIPS术和门奇断流术均可有效降低门静脉压力,改善肠道生物屏障功能。TIPS术创伤小,不加重全身及局部炎症反应及免疫应激。而断流术,创伤较大,短期内会增加全身及局部炎症反应及免疫应激。
[Abstract]:Objective: to observe the effects of intrahepatic portosystemic shunt (TIPS) and portal azygous devascularization on inflammatory mediators, cytokines and intestinal flora in patients with portal hypertension of liver cirrhosis.To explore the difference between the two surgical methods on systemic inflammatory response and intestinal biological barrier.Methods: the levels of TNF- 伪 IL-1 尾 IL-6 and MDA in portal vein, hepatic vein and inferior vena cava were measured by ELISA, nitrate reduction and thiobarbituric acid in 22 patients with portal hypertension and 10 patients with porta-azygous devascularization before and one week after operation.Gradient denaturing gel electrophoresis was used to determine the changes of intestinal flora before and after operation.Results the portal vein pressure in the two groups was significantly lower than that in the control group (P 0.05). The inflammatory mediators and MDA in the tips group were not significantly changed after operation.The levels of no in portal vein and hepatic vein were significantly decreased in the disconnection group, and the intestinal flora was also significantly decreased in the tips group and the preoperation group as well as in the intestinal microflora. The levels of inflammatory mediators and MDA in the disconnection group were significantly higher than those in the preoperation group, and the levels of no in the portal vein and hepatic vein were significantly decreased in the tips group and the disconnection group.Conclusion both the TIPS and the portazygous devascularization can effectively reduce the portal vein pressure and improve the intestinal biological barrier function. Tips has less trauma and does not aggravate the systemic and local inflammatory reaction and immune stress.In the short term, the systemic and local inflammatory reaction and immune stress were increased.
【学位授予单位】：南京大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.3

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