• 1.云南省第一人民醫(yī)院普外科（昆明650032）;;
  • 2.重慶醫(yī)科大學第一附屬醫(yī)院外科（重慶400016）;

目的探討小腸移植后腸道細菌移位的原因和防治方法。方法綜述小腸移植與腸道細菌移位的相關(guān)文獻。結(jié)果移植小腸缺血再灌注損傷，免疫排斥反應(yīng)，移植物抗宿主病和免疫抑制劑的應(yīng)用都會導致腸粘膜屏障功能損害，腸蠕動和運輸功能紊亂，腸道內(nèi)條件致病菌過度生長，細菌和毒素向腸外組織器官移位，引起受體感染。結(jié)論小腸移植后腸道細菌移位的發(fā)生率較高，是引起受體感染，影響預后的一個主要因素。提高腸移植外科技能，縮短缺血保存時間，選擇性腸道去污，改進營養(yǎng)支持和免疫抑制方案，有望減少腸移植后細菌移位，降低感染并發(fā)癥，提高預后指標。

引用本文： 羅世成綜述,時德審校. 小腸移植與腸道細菌移位. 中國普外基礎(chǔ)與臨床雜志, 2002, 9(4): 288-290. doi: 復制

1. Bueno J, Ohwada S, Kocoshis S, et al. Factors impacting the survival of children with intestinal failure referred for intestinal transplantation [J]. J Pediatr Surg, 1999； 34(1)∶27.
2. Grant D. Intestinal transplantation: 1997 report of the international registry. Intestinal Transplant Registry [J]. Transplantation, 1999； 67(7)∶1061.
3. Asfar S, Atkison P, Ghent C, et al. Small bowel transplantationA lifesaving option for selected patients with intestinal failure [J]. Dig Dis Sci, 1996； 41(5)∶875.
4. Nieuwenhuijzen GA, Deitch EA, Goris RJ. Infection, the gut and the development of the multiple organ dysfunction syndrome [J]. Eur J Surg, 1996； 162(4)∶259.
5. van der Waaij D. Colonization pattern of the digestive tract by potentially pathogenic microorganisms: colonizationcontrolling mechanisms and consequences for antibiotic treatment [J]. Infection, 1983； 11(Suppl 2)∶S90.
6. Adams DH, Shaw S. Leucocyteendothelial interactions and regulation of leucocyte migration [J]. Lancet, 1994； 343(8901)∶831.
7. Beuk RJ, Heineman E, Tangelder GJ, et al. Total warm ischemia and reperfusion impairs flow in all rat gut layers but increases leukocytevessel wall interactions in submucosa only [J]. Ann Surg, 2000； 231(1)∶96.
8. Massberg S, Gonzalez AP, Leiderer R, et al. In vivo assessment of the influence of cold preservation time on microvascular reperfusion injury after experimental small bowel transplantation [J]. Br J Surg, 1998； 85(1)∶127.
9. Gianotti L, Bergamo C, Braga M, et al. In vivo evaluation of timing, degree, and distribution of bacterial translocation following experimental small bowel transplantation [J]. Transplantation, 1995； 60(9)∶891.
10. Ogita K, Hopkinson K, Nakao M, et al. Stress responses in graft and native intestine after rat heterotopic small bowel transplantation [J]. Transplantation, 2000； 69(11)∶2273.
11. Lee TK, Heeckt P, Smith SD, et al. Postoperative selective bowel decontamination prevents gramnegative bacterial translocation in smallbowel graft recipients [J]. J Surg Res, 1995； 58(5)∶496.
12. Nakada K, Ikoma A, Suzuki T, et al. Longterm effect of jejunoileal autotransplantation on motility and transit time in canine small bowel [J]. Transplant Proc, 1994； 26(3)∶1635.
13. Sigurdsson L, Reyes J, Kocoshis SA, et al. Bacteremia after intestinal transplantation in children correlates temporally with rejection or gastrointestinal lymphoproliferative disease [J]. Transplantation, 2000； 70(2)∶302.
14. Price BA, Cumberland NS, Clark CL, et al. The effect of rejection and graftversushost disease on small intestinal microflora and bacterial translocation after rat small bowel transplantation [J]. Transplantation, 1993； 56(5)∶1072.
15. Oishi M, Tanaka N, Orita K. Successful swine small bowel transplantation using FK506: effect on endotoxin translocation [J]. Transplant Proc, 1994； 26(4)∶2302.
16. Fryer J, Grant D, Jiang J, et al. Influence of macrophage depletion on bacterial translocation and rejection in small bowel transplantation [J]. Transplantation, 1996； 62(5)∶553.
17. Kellersman R, Zhong R, Kiyochi H, et al. Reconstruction of the intestinal lymphatic drainage after small bowel transplantation [J]. Transplantation, 2000； 69(1)∶10.
18. Li YS, Li JS, Jiang JW, et al. Glycylglutamineenriched longterm total parenteral nutrition attenuates bacterial translocation following small bowel transplantation in the pig [J]. J Surg Res, 1999； 82(1)∶106.
19. Zhang W, Frankel WL, Bain A, et al. Glutamine reduces bacterial translocation after small bowel transplantation in cyclosporinetreated rats [J]. J Surg Res, 1995； 58(2)∶159.
20. de Oca J, Bettonica C, Cuadrado S, et al. Effect of oral supplementation of ornithinealpha ketoglutarate on the intestinal barrier after orthotopic small bowel transplantation [J]. Transplantation, 1997； 63(5)∶636.
21. Biffi R, Privitera G, Pozzi S, et al. Postoperative enteral feeding does not prevent intestinal bacterial translocation, but reduces the rate of pulmonary infections in pigs undergoing total orthotopic small bowel transplantation [J]. Eur J Surg, 1997； 163(9)∶703.
22. Zhang W, Frankel WL, Adamson WT, et al. Insulinlike growth factorⅠ improves mucosal structure and function in transplanted rat small intestine [J]. Transplantation, 1995； 59(5)∶755.
23. Biffi R, Privitera G, Andreoni B, et al. Luminal bacterial overgrowth and intestinal translocation in pigs given either cyclosporin A or 15deoxyspergualin after small bowel transplantation [J]. Eur J Surg, 1995； 161(2)∶93.
24. Langrehr JM, Machens C, Zill E, et al. Bacterial translocation during graftversushost disease after small bowel transplantation is reduced following inhibition of inducible nitric oxide synthesis [J]. Transplantation, 2000； 69(11)∶2415.
  1. 1. Bueno J, Ohwada S, Kocoshis S, et al. Factors impacting the survival of children with intestinal failure referred for intestinal transplantation [J]. J Pediatr Surg, 1999； 34(1)∶27.
  2. 2. Grant D. Intestinal transplantation: 1997 report of the international registry. Intestinal Transplant Registry [J]. Transplantation, 1999； 67(7)∶1061.
  3. 3. Asfar S, Atkison P, Ghent C, et al. Small bowel transplantationA lifesaving option for selected patients with intestinal failure [J]. Dig Dis Sci, 1996； 41(5)∶875.
  4. 4. Nieuwenhuijzen GA, Deitch EA, Goris RJ. Infection, the gut and the development of the multiple organ dysfunction syndrome [J]. Eur J Surg, 1996； 162(4)∶259.
  5. 5. van der Waaij D. Colonization pattern of the digestive tract by potentially pathogenic microorganisms: colonizationcontrolling mechanisms and consequences for antibiotic treatment [J]. Infection, 1983； 11(Suppl 2)∶S90.
  6. 6. Adams DH, Shaw S. Leucocyteendothelial interactions and regulation of leucocyte migration [J]. Lancet, 1994； 343(8901)∶831.
  7. 7. Beuk RJ, Heineman E, Tangelder GJ, et al. Total warm ischemia and reperfusion impairs flow in all rat gut layers but increases leukocytevessel wall interactions in submucosa only [J]. Ann Surg, 2000； 231(1)∶96.
  8. 8. Massberg S, Gonzalez AP, Leiderer R, et al. In vivo assessment of the influence of cold preservation time on microvascular reperfusion injury after experimental small bowel transplantation [J]. Br J Surg, 1998； 85(1)∶127.
  9. 9. Gianotti L, Bergamo C, Braga M, et al. In vivo evaluation of timing, degree, and distribution of bacterial translocation following experimental small bowel transplantation [J]. Transplantation, 1995； 60(9)∶891.
  10. 10. Ogita K, Hopkinson K, Nakao M, et al. Stress responses in graft and native intestine after rat heterotopic small bowel transplantation [J]. Transplantation, 2000； 69(11)∶2273.
  11. 11. Lee TK, Heeckt P, Smith SD, et al. Postoperative selective bowel decontamination prevents gramnegative bacterial translocation in smallbowel graft recipients [J]. J Surg Res, 1995； 58(5)∶496.
  12. 12. Nakada K, Ikoma A, Suzuki T, et al. Longterm effect of jejunoileal autotransplantation on motility and transit time in canine small bowel [J]. Transplant Proc, 1994； 26(3)∶1635.
  13. 13. Sigurdsson L, Reyes J, Kocoshis SA, et al. Bacteremia after intestinal transplantation in children correlates temporally with rejection or gastrointestinal lymphoproliferative disease [J]. Transplantation, 2000； 70(2)∶302.
  14. 14. Price BA, Cumberland NS, Clark CL, et al. The effect of rejection and graftversushost disease on small intestinal microflora and bacterial translocation after rat small bowel transplantation [J]. Transplantation, 1993； 56(5)∶1072.
  15. 15. Oishi M, Tanaka N, Orita K. Successful swine small bowel transplantation using FK506: effect on endotoxin translocation [J]. Transplant Proc, 1994； 26(4)∶2302.
  16. 16. Fryer J, Grant D, Jiang J, et al. Influence of macrophage depletion on bacterial translocation and rejection in small bowel transplantation [J]. Transplantation, 1996； 62(5)∶553.
  17. 17. Kellersman R, Zhong R, Kiyochi H, et al. Reconstruction of the intestinal lymphatic drainage after small bowel transplantation [J]. Transplantation, 2000； 69(1)∶10.
  18. 18. Li YS, Li JS, Jiang JW, et al. Glycylglutamineenriched longterm total parenteral nutrition attenuates bacterial translocation following small bowel transplantation in the pig [J]. J Surg Res, 1999； 82(1)∶106.
  19. 19. Zhang W, Frankel WL, Bain A, et al. Glutamine reduces bacterial translocation after small bowel transplantation in cyclosporinetreated rats [J]. J Surg Res, 1995； 58(2)∶159.
  20. 20. de Oca J, Bettonica C, Cuadrado S, et al. Effect of oral supplementation of ornithinealpha ketoglutarate on the intestinal barrier after orthotopic small bowel transplantation [J]. Transplantation, 1997； 63(5)∶636.
  21. 21. Biffi R, Privitera G, Pozzi S, et al. Postoperative enteral feeding does not prevent intestinal bacterial translocation, but reduces the rate of pulmonary infections in pigs undergoing total orthotopic small bowel transplantation [J]. Eur J Surg, 1997； 163(9)∶703.
  22. 22. Zhang W, Frankel WL, Adamson WT, et al. Insulinlike growth factorⅠ improves mucosal structure and function in transplanted rat small intestine [J]. Transplantation, 1995； 59(5)∶755.
  23. 23. Biffi R, Privitera G, Andreoni B, et al. Luminal bacterial overgrowth and intestinal translocation in pigs given either cyclosporin A or 15deoxyspergualin after small bowel transplantation [J]. Eur J Surg, 1995； 161(2)∶93.
  24. 24. Langrehr JM, Machens C, Zill E, et al. Bacterial translocation during graftversushost disease after small bowel transplantation is reduced following inhibition of inducible nitric oxide synthesis [J]. Transplantation, 2000； 69(11)∶2415.