Syk I, Brunkwall J, Ivancev K, Lindblad B, Montgomery A, Wellander E, Wisniewski J, Risberg B
Department of Surgery, Malmö University Hospital, Lund University, Sweden.
Eur J Vasc Endovasc Surg. 1998 May;15(5):398-405. doi: 10.1016/s1078-5884(98)80200-1.
To study bowel ischaemia in transfemorally placed endoluminal grafting (TPEG) for abdominal aortic aneurysms, and any relation to cytokine response or postoperative fever.
Prospective not randomised. University hospital setting.
Fourteen cases of conventional surgery and 23 cases of endovascular technique for infrarenal abdominal aortic aneurysm repair.
Tonometry was used for sigmoid colon pH, and ELISAs for serum IL-6.
Mucosal pH in the sigmoid colon fell significantly during clamping and reperfusion in both groups. Lowest measured sigmoid colon pH was 7.10 in the open group, compared to 7.22 in the TPEG group (p < 0.05). The IL-6 levels in serum peaked after 4 h of reperfusion; 249 pg/ml in the open group, compared to 89 pg/ml in the TPEG group (p < 0.05). High levels of IL-6 in the postoperative period and persisting low sigmoidal pH were associated with serious complications. Postoperative temperature did not differ significantly between the groups, and no significant correlation could be found with sigmoid colon pH or IL-6 levels.
The less pronounced perioperative bowel ischaemia in TPEG patients indicates an advantage of the TPEG technique. Splanchnic ischaemia was not related to postoperative fever, nor the IL-6 or TNF response.
研究经股动脉腔内血管移植术（TPEG）治疗腹主动脉瘤时的肠缺血情况，以及与细胞因子反应或术后发热的任何关系。
前瞻性非随机研究。大学医院环境。
14例传统手术和23例采用血管内技术修复肾下腹主动脉瘤的病例。
使用张力测定法测量乙状结肠pH值，采用酶联免疫吸附测定法（ELISA）检测血清白细胞介素-6（IL-6）。
两组在夹闭和再灌注期间乙状结肠黏膜pH值均显著下降。开放手术组测得的最低乙状结肠pH值为7.10，而TPEG组为7.22（p<0.05）。血清IL-6水平在再灌注4小时后达到峰值；开放手术组为249 pg/ml，TPEG组为89 pg/ml（p<0.05）。术后IL-6水平升高和乙状结肠pH值持续偏低与严重并发症相关。两组术后体温无显著差异，且与乙状结肠pH值或IL-6水平无显著相关性。
TPEG患者围手术期肠缺血不明显，表明TPEG技术具有优势。内脏缺血与术后发热、IL-6或肿瘤坏死因子（TNF）反应均无关。
