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Purpose: Bacterial endotoxin is a cell wall of Gram-negative bacteria LPS (lipopolysaccharide; LPS) and traces of protein (Protein) complex, which is released after disintegration of the bacteria die or out of a biological having endotoxin active substances. Its chemical composition mainly by O-specific chain, core polysaccharide, lipid A consists of three parts, wherein lipid A (Lipida) endotoxin toxicity or biological activity of the main group. The group is not species-specific, similar to its toxicity, such as fever, hemodynamic changes, disseminated intravascular coagulation, and can lead to shock, with its pathogenesis, mainly lipopolysaccharide (LPS) concentration in the body State Value (gt; 0.005ng/ml), can induce endogenous pyrogens such as tumor necrosis factor, interleukin and β2-interferon. These factors cause the body to stimulate the thermoregulatory center, fever, and bacterial endotoxins, either directly or indirectly on almost all organs and tissues, the pathological changes is extremely broad, lymph, spleen, liver, kidney, bone marrow can be violated, the affected tissue occurred congestion, edema and necrosis, resulting in tissue and organ dysfunction. Tumor necrosis factor (TNF) in a human body, there are two molecular forms, called TNF-α, the other is called TNF-β. TNFα caused by bacterial lipopolysaccharide activated monocytes - macrophages, also known as cachectin (cachectin); TNF-β by the antigen or mitogen-stimulated lymphocytes, also known as lymphotoxin (lymphotoxin, LT), they the body has a variety of biological effects, such as: anti-tumor and anti-tumor effect, antiviral, immunomodulatory effects, induce inflammation, stimulate the release of inflammatory mediators, on the role of connective tissue. Present study suggests that lipopolysaccharide (LPS) is a body as a result of tumor necrosis factor (TNF) release strongest stimulus. This study was designed for esophageal cancer patients peripheral blood plasma endotoxin level of continuous monitoring, to clarify preoperative and postoperative esophageal cancer patients peripheral blood plasma endotoxin levels are undifferentiated; surgical treatment of thoracic duct ligation or not, for patients with postoperative fasting state plasma levels of endotoxin whether the impact; investigate whether the thoracic duct after fasting state intestinal endotoxin translocation main ways; endotoxin and tumor necrosis factor correlation between, Thoracic Surgery for the treatment of esophageal cancer surgery should prevent thoracic duct ligation to provide reliable data basis and to avoid postoperative SIRS, MODS, even MOF and other complications, reduce postoperative pain, reduce patient treatment procedures and treatment burden on health care resources, provide certain data. Methods: Blood samples were obtained from the Fourth Hospital of Hebei Medical University, Thoracic Surgery, November 2006 - February 2007 OK esophageal squamous cell cancer surgery 72 patients hospitalized, the application immediately table method, were randomized into the experimental group (ligation group) and the control group (not bar group), according to the surgical outcome, will simply exploratory surgery and palliative surgery and postoperative complications were excluded, the remaining cases, 63 cases, aged 50 to 65 years, mean age 58.2 years, and the experimental group (ligation group) 33 cases and the control group (not bar group) 30 cases, which were 36 males and 27 females, male to female ratio was 1.33:1, (male and lt; 58.2 years 16 cases, gt; 58.2 years old in 20 cases, female lt; 58.2 years in 12 cases, gt; 58.2 years 15 cases). According to UICC esophageal squamous cell carcinoma international TNM staging criteria (2002), T112 cases, T229 cases, T322 cases; N025 case, N138 cases; Ⅰ in 7 cases, Ⅱ a period of 21 cases, Ⅱ b in 13 cases, Ⅲ 22 cases. Surgery underwent esophageal cancer cure, breast, esophagus and stomach abdominal lymph node dissection aortic arch anastomosis, gastric retention continues to attract patients, exhaust removal (5 days), and fasted seven days, the application of the same antibiotics and are does not apply to protect the intestinal mucosa and reduce inflammation drugs, relying solely on parenteral (intravenous) nutrition, no postoperative anastomotic leakage, bleeding, lung, heart, chylothorax, shock, diaphragmatic hernia and other complications. Blood samples were sterilized case, at 14:00 pm, taking the patient elbow venous blood samples obtained after centrifugation the supernatant (plasma), double-antibody sandwich enzyme-linked immunosorbent assay (double antibody sandwich ELISA) determination of endotoxin and tumor necrosis factor levels. The resulting test data accordingly two-sample t test, paired t-test, randomized block analysis of variance (ANOVA analysis), Spearman rank correlation test, with P lt; 0.05 was considered statistically significant, analysis of thoracic duct ligation on plasma endotoxin and Tumor necrosis factor levels, and to explore whether the thoracic duct endotoxin translocation the main way. Results: 1 Age and sex on plasma endotoxin and TNF-α level was no significant difference in effect (P = 0.296, P gt; 0.05). (2) first to the fifth day after surgery, the plasma levels of endotoxin and TNF-α levels were elevated a great extent. Thoracic duct ligation group and non-group tie endotoxin and TNF-α levels compared before and after surgery, there was a significant difference (P = 0.0000, P lt; 0.01), significantly higher than the preoperative patients. Began to increase from the surgery, the third peak, the fifth day after, the down to the first postoperative day the same level, and the level down to the trend of the day before surgery. 3 esophageal cancer patients undergoing thoracic duct ligation group after plasma endotoxin and TNF-α levels and did not tie group, there was a significant difference (P = 0.0000, P lt; 0.01), tie ligation group was significantly lower than groups. Thoracic duct ligation reduces postoperative plasma endotoxin levels. 4 ligation group and non-group tie endotoxin and TNF-α level changes before and after surgery can be manifested in the form of curves. Time as the abscissa, endotoxin and TNF-α levels for the vertical axis, two curves trend comparison, there are very significant differences (P = 0.0000, P lt; 0.01). Starting point for the two curves are essentially coincident, but not tie group curve rises steeply than the ligation group, and the peak was significantly higher than ligation group; does not tie still slightly higher than the group of curves end ligation group, but there is an overlap between the two trends. 5 of plasma TNF-α levels with endotoxin levels increased, following the third postoperative day, along with the peak levels of endotoxin, plasma TNF-α levels peaked after the daily decline to postoperative five days time, down to the level of the first postoperative day, TNF-α level of change is always accompanied by endotoxin level change, both of the same trend. Plasma endotoxin and TNF-α level was positively correlated r = 0.979 (P = 0.000, P lt; 0.01). 6 thoracic duct ligation can reduce the incidence of postoperative SIRS. Ligation group and did not tie group after the first, third, fifth day of the incidence of SIRS pairwise comparison, there was a significant difference (P = 0.0000, P lt; 0.01). Conclusions: 1. Esophageal resection plasma endotoxin and TNF-α levels with age and sex. (2) whether ligation or ligation of the thoracic duct, esophageal resection in patients with plasma endotoxin and TNF-α levels, higher than that before surgery. 3 esophageal resection in patients with thoracic duct ligation plasma endotoxin and TNF-α levels were significantly lower in patients without thoracic duct ligation. 4 Whether ligation or ligation of the thoracic duct, the third postoperative day endotoxin and TNF-α levels peaked after day decline. 5 Prevention thoracic duct ligation can not only prevent the occurrence of postoperative chylothorax, and for blocking endotoxin shift is important. Thoracic duct may be the main way of endotoxin. 6 esophagectomy thoracic duct ligation surgery can reduce the incidence of postoperative SIRS, esophageal cancer surgery recommended prophylactic thoracic duct ligation.
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