| Objectives:To explore the effect of gastrointestinal system congestion and reperfusion injury on the gastrointestinal mucosal barrier and liver function during the perioperative period of hepatectomy due to portal vein occlusion,and its intrinsic mechanism.Methods:Fifty patients were selected from the First Affiliated Hospital of Kunming Medical University from January 2017 to January 2019,who underwent hepatectomy in the Department of Hepatobiliary Surgery and Organ Transplantation.All patients had normal liver function before operation and NYHA grade ???.According to the intraoperative blockage of the portal vein,the unblocked group and the blocking group were divided into two groups.The blocking group was subgrouped according to the length of the blocking time.The blocking time was within 15 minutes to block the group A.The blocking time was 15 minutes to 30 minutes for blocking group B,blocking time for more than 30 minutes for blocking group C,20 patients without blocking group,blocking A,blocking B,blocking C for 10 groups.All patients were recorded for gender,age,height,weight,intraoperative blood loss,length of surgery,site of hepatectomy,and total length of hospital stay.All patients underwent general anesthesia according to routine,continuous monitoring of ECG,SP02,PETCO2,invasive blood pressure,intermittent monitoring of CVP5 blood samples collected at different time points during the operation,determination of serum diamine oxidase,endotoxin,tumor Necrosis factor-a.The time of blood collection in the unblocked group was TO(preoperative),T1(before lesion hepatectomy),T2(when diseased hepatectomy was performed),and T3(completed surgery),The time of blood collection for blocking A,blocking B,and blocking C was TO(preoperative),T1(end of portal vein occlusion),T2(opening of portal vein for 2 hours),and T3(completed surgery).At the different time monitoring points,3 ml of blood was collected from the intermal jugular vein and placed in the blood collection tube.After stratification with blood,it was centrifuged at 4000 r/min for 15 min,and the supernatant was stored in a refrigerator at-80 0 C for storage.Dianine oxidase was detected by spectrophotometry,endotoxin was detected by endpoint chromogenic assay,and tumor necrosis factor-a was detected by enzyme-linked immunosorbent assay.The liver function related indicators of the patients were followed up and detected by the automatic biochemical analyzer rate method.Results:1.Comparison of hepatic lobe resection and intraoperative conditions:There was no difference in the resection of hepatic lobe between the four groups(P>0.05),There were no signifieant differences in the duration of surgery,intraoperative blood loss and average hospital stay between the four groups(P>0.05).2.Comparison of DAO content:At TO,there was no significant difference in DAO between the four groups(P>0.05).At T1,the level of DAO in the block C group was significantly higher than that in the other groups(P<0.05).At T2,the level of DAO in group B and group C was significantly higher than that in unblocked group(P<0.05).The level of DAO in group C was significantly higher than that in group A and group B(P<0.05).At T3,the DAO levels in the three blocking groups were higher than the unblocked group(P<0.05),and the blocking group C was higher than the blocking group B than the blocking group A(P<0.05).3.Comparison of endotoxin levels:At TO and T1,there was no significant difference in endotoxin eontent between the four groups(P>0.05).At T2,the endotoxin content in the block C group was higher than that in the unblocked group(P<0.05).At T3,the endotoxin content in the block B group and the block C group were higher than the unblocked group(P<0.05).4.Comparison of ALT content:The liver function of all patients before operation was normal,there was no statistical difference(P>0.05).The ALT levels of the four groups,ere increased after the operation,and the liver enzymes gradually decreased.On the first day and the seeond day after surgery,there were signifieant differences in ALT between the three groups(P<0.05).The liver enzymes in the block groups were higher than the unblocked group;Compared with group A?group B and group C were blocked,and liver enzymes in group B and group C were higher than group A(P<0.05);Compared with the blocking group B,the blocking group C had higher liver enzymes than the blocking group B(P<0.05);On the third postoperative day,there was no significant difference in liver enzymes between the block A group and the unblocked group(P>0.05);There was still a statistical difference between the unblocked group and the block B group and the block group C.The block group C was higher than the block group B than the unblocked group(P<0.05).5·Comparison of TNF-? concentrations:There were no significant differences in TNF-? between the four groups at TO and T1(P>0.05).At T2,the concentration of TNF-? in group B and group C was blocked.Compared with the unblocked group,the difference was statistically significant(P<0.05).The concentration of TNF-? in the block B group and the block C group was higher than that in the block A group,the difference was statistically significant(P<0.05).The blocking group C was higher than the blocking group B(P<0.05);at T3,the concentration of TNF-? in the blocking group B and blocking group C was higher than that in the unblocked group(P<0.05),blocking B.The concentration of TNF-? in the group and the blocking group C was higher than that in the blocking group A,and the difference was statistically significant(P<0.05).Conclusions:1)Blocking the portal vein can cause damage to the intestinal mucosal barrier.The longer the blocking time,the heavier the intestinal mucosal damage.2)When the portal vein was blocked for more than 15 minutes,intestinal congestion and reperfusion caused significant damage to the liver.When the blocking time exceeded 30 minutes,the intestinal reperfusion caused more damage to the liver.3)With the prolongation of portal vein blockage,the intestinal mucosal barrier function is impaired,leading to endotoxemia,intestinal bacterial translocation,and activation of Kupffer cells to secrete TNF-?,which is the main mechanism of intestinal congestion and reperfusion injury to the liver. |
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