Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
Shock. 2011 Jan;35(1):9-16. doi: 10.1097/SHK.0b013e3181ed8f17.
Bacterial translocation (BT) is suspected to play a major role in the development of infections in surgical patients. However, the clinical association between intestinal barrier dysfunction, BT, and septic morbidity has remained unconfirmed. The objective of this study was to study BT in patients undergoing major abdominal surgery and the effects of probiotics, selective decontamination of the digestive tract (SDD), and standard treatment on intestinal barrier function. In a randomized controlled setting, 30 consecutive patients planned for elective pylorus-preserving pancreaticoduodenectomy (PPPD) were allocated to receive perioperatively probiotics, SDD, or standard treatment. To assess intestinal barrier function, intestinal fatty acid-binding protein (mucosal damage) and polyethylene glycol recovery (intestinal permeability) in urine were measured perioperatively. BT was assessed by real-time polymerase chain reaction and multiplex ligation-dependent probe amplification (MLPA) in mesenteric lymph nodes (MLNs) harvested early (baseline control) and at the end of surgery ("end-of-surgery" MLNs, after 3h in PPPD patients). Polymerase chain reaction detected bacterial DNA in 18 of 27 end-of-surgery MLNs and in 13 of 23 control MLNs (P = 0.378). Probiotics and SDD had no significant effect on the number of positive MLNs or the change in bacterial DNA during operation. Multiplex ligation-dependent probe amplification analysis showed significantly increased expression of only 4 of 30 inflammatory mediator-related genes in end-of-surgery compared with early sampled MLN (P < 0.05). Polyethylene glycol recovery was unaffected by operation, probiotics and SDD as compared with standard treatment. Intestinal fatty acid-binding protein levels were increased shortly postoperatively only in patients treated with SDD (P = 0.02). Probiotics and SDD did not influence BT, intestinal permeability, or inflammatory mediator expression. Bacterial translocation after abdominal surgery may be part of normal antigen-sampling processes of the gut.
细菌易位（BT）被怀疑在外科患者感染的发展中起主要作用。然而，肠道屏障功能障碍、BT 和脓毒症发病率之间的临床关联尚未得到证实。本研究的目的是研究接受大腹部手术的患者中的 BT 以及益生菌、选择性消化道去污染（SDD）和标准治疗对肠道屏障功能的影响。在随机对照环境中，将 30 名连续计划接受保留幽门的胰十二指肠切除术（PPPD）的患者随机分配接受围手术期益生菌、SDD 或标准治疗。为了评估肠道屏障功能，在手术期间测量尿液中的肠脂肪酸结合蛋白（黏膜损伤）和聚乙二醇回收率（肠道通透性）。通过实时聚合酶链反应和多重连接依赖性探针扩增（MLPA）在肠系膜淋巴结（MLN）中评估 BT，这些 MLN 是在早期（基线对照）和手术结束时（PPPD 患者手术结束时的“手术结束时”MLN）收获的。聚合酶链反应在 27 个手术结束时的 MLN 中的 18 个和 23 个对照 MLN 中的 13 个中检测到细菌 DNA（P = 0.378）。益生菌和 SDD 对阳性 MLN 的数量或手术期间细菌 DNA 的变化没有显著影响。多重连接依赖性探针扩增分析显示，与早期采样的 MLN 相比，仅在手术结束时的 MLN 中发现 30 个炎症介质相关基因中的 4 个表达显著增加（P <0.05）。与标准治疗相比，手术、益生菌和 SDD 对聚乙二醇回收率没有影响。仅在接受 SDD 治疗的患者中，手术后不久肠脂肪酸结合蛋白水平才会升高（P = 0.02）。益生菌和 SDD 不影响 BT、肠道通透性或炎症介质表达。腹部手术后的细菌易位可能是肠道正常抗原采样过程的一部分。
