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目的了解肝硬化患者肠道细菌易位(BT)的发生率及其相关危险因素,分析BT与术后感染的关系。方法对77例肝移植和1例未行肝移植的肝硬化患者进行术中采样,取外周血、门脉血及肠系膜淋巴结(MLN),分别进行需氧及厌氧培养,了解BT的发生率。结合术前、术后各种临床资料分析发生BT的危险因素及BT的临床意义。结果78例肝硬化患者中BT的发生率为10·3%(8/78);细菌易位的部位以MLN为主,占5/8,发生BT的细菌主要是肠道G-兼性厌氧杆菌(55·6%),其次为G+兼性厌氧球菌(22·2%)。BT组患者术前胆红素总量显著高于无BT组(P=0·022);发生BT的患者其术后感染的风险是无BT患者的1·3倍。结论高胆红素血症是促发BT的独立危险因素,发生BT的肝移植患者术后感染的风险明显升高。
Objective To investigate the incidence of intestinal bacterial translocation (BT) in cirrhotic patients and its related risk factors, and analyze the relationship between BT and postoperative infection. Methods Totally 77 patients with liver transplantation and 1 liver cirrhosis without liver transplantation were enrolled in this study. Peripheral blood, portal vein blood and mesenteric lymph nodes (MLN) were collected for aerobic and anaerobic culture respectively to understand the incidence of BT . Combined with preoperative and postoperative various clinical data to analyze the risk factors of BT and the clinical significance of BT. Results The incidence of BT in 78 cirrhotic patients was 10.3% (8/78). The predominant sites of bacterial translocations were MLN, accounting for 5/8. The BT-producing bacteria were predominantly intestinal G- Aerobacter (55.6%), followed by G + facultative anaerobe (22.2%). The total preoperative bilirubin in BT group was significantly higher than that in non BT group (P = 0.022). The risk of postoperative infection in patients with BT was 1.3 times higher than that in patients without BT. Conclusion Hyperbilirubinemia is an independent risk factor for BT, and the risk of postoperative infection in patients with BT is significantly increased.