胆道术后腹腔引流液中炎性因子检测对胆瘘早期诊断的研究

目的通过观察胆道术后腹腔引流液中炎性细胞因子水平变化,衡量其作为早期预测和诊断胆瘘指标的意义。方法总结3227例胆道手术患者相关临床资料,观察胆瘘发生与年龄、性别、手术方式、手术时间等指标的关系,并于术后1,3,5d检测患者腹腔引流液和血清标本中IL-6,IL-8,IL-10,TNF-α和CRP变化,比较胆瘘组(17例)和非胆瘘组(3210例)上述指标的差异。结果胆瘘发生与患者年龄、性别、腔镜或开腹手术方式无关(P0.05),与手术时长短、术中出血量多少、胆总管直径大小有关(P0.05),其术后腹腔引流液细胞因子水平显著高于非胆瘘组和血清水平。结论腹腔引流液炎性细胞因子水平是反应腹腔内炎症的敏感指标,有助于早期发现胆瘘,避免严重后果。

Study of peritoneal cytokine measurement for early prediction of biliary fistula after biliary operations

Objective: To investigate the diagnostic and predictive value of measuring peritoneal inflammatory cytokines  in predicting biliary fistulas in patients undergoing biliary surgery.
 Methods: Peritoneal samples and serum samples of 3227 biliary surgery patients were collected on the first, third, fifth postoperative day, and IL-6, IL-8, IL-10, TNF-α and CRP of the samples were measured. Patients were divided into two groups: those with clinical evidence of biliary fistulas and those without any evidence of biliary fistulas.The age, sex, operative method and operative time between the two groups were compared.
 Results: There was a negative correlation between biliary fistulas and age, sex and operation mode; but blood loss, operation time and common bile duct diameter had positive correlation with biliary fistulas. Peritoneal cytokine levels were significantly higher in patients with biliary fistulas as compared to those without biliary fistulas.
 Conclusions: The peritoneal cytokine level is a sensitive parameter of peritoneal inflammation and can be as an additional diagnostic tool for the early prediction of biliary fistulas after biliary surgery.