本文選題：經(jīng)頸內(nèi)靜脈門體分流術(shù)　切入點(diǎn)：門奇斷流術(shù)　出處：《南京大學(xué)》2015年碩士論文

【摘要】：目的:通過觀察經(jīng)頸內(nèi)靜脈肝內(nèi)門體分流術(shù)(TIPS)及門奇斷流術(shù)對肝硬化門脈高壓癥患者炎性介質(zhì)、細(xì)胞因子及腸道菌群的影響,探討兩種手術(shù)方式對于全身炎癥反應(yīng)及腸道生物屏障影響的差異性。方法:對22例因門脈高壓癥行TIPS患者和10例行門奇斷流術(shù)患者,用ELISA法、硝酸氮還原法和硫代巴比妥酸法分別測定術(shù)前及術(shù)后一周的門靜脈、肝靜脈及下腔靜脈中TNF-α,IL-1β,IL-6,NO和MDA水平。應(yīng)用梯度變性凝膠電泳法測定術(shù)前及術(shù)后一月腸道菌群的變化。結(jié)果:TIPS組和斷流術(shù)組術(shù)后門靜脈壓力均有顯著降低(P0.05)。TIPS組炎癥介質(zhì)及MDA在術(shù)后未見明顯變化(P0.05)。斷流術(shù)組炎癥介質(zhì)及MDA在術(shù)后明顯升高(P0.05)。TIPS組和斷流術(shù)組NO水平在門靜脈和肝靜脈處明顯降低(P0.05),腸道菌群量較術(shù)前也顯著減少(P0.05)。結(jié)論:TIPS術(shù)和門奇斷流術(shù)均可有效降低門靜脈壓力,改善腸道生物屏障功能。TIPS術(shù)創(chuàng)傷小,不加重全身及局部炎癥反應(yīng)及免疫應(yīng)激。而斷流術(shù),創(chuàng)傷較大,短期內(nèi)會增加全身及局部炎癥反應(yīng)及免疫應(yīng)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- 偽 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.
【學(xué)位授予單位】：南京大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R657.3

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