Infectious implications in the porcine model of natural orifice transluminal endoscopic surgery (NOTES) with PEG-tube closure: a quantitative bacteriologic study
Infectious implications in the porcine model of natural orifice transluminal endoscopic surgery (NOTES) with PEG-tube closure: a quantitative bacteriologic study
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DOI：
10.1016/j.gie.2007.11.054
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发表时间：
2008-08-01
影响因子：
7.7
通讯作者：
Ponsky, Jeffrey L.
中科院分区：
文献类型：
--
作者：
Mcgee, Michael E.;Marks, Jeffrey M.;Ponsky, Jeffrey L.
背景：获得可靠的经内脏缺损闭合目前限制了自然孔腔内窥镜手术（NOTES）。PEG管是处理NOTES胃切开术的潜在手段。目的：探讨人工耳蜗置换术后PEG闭合的疗效。设计：实验动物研究环境：实验室干预措施：猪接受生理盐水、氯霉素或不洗胃，然后进行经胃NOTES腹膜镜检查。术中通过内窥镜进行培养。腹腔内留下无菌异物，用20F PEG管关闭胃切开术。动物观察14天，进行无菌剖腹手术。进行异物和腹腔培养。主要观察指标：脓肿率，腹膜定量培养。结果：排除麻醉并发症后，19只动物行NOTES；术后全期存活18例（94.7%）。1只动物在术后第2天PEG管移位后死亡。第14天腹腔脓肿5只（27.8%），腹膜培养阳性8只（44.4%），培养中异物污染9只（50%）。感染并发症不受手术时灌胃方式或腹膜细菌接种方式的影响。结论：NOTES胃切开术的PEG闭合与亚临床腹内脓肿形成有关，如果在术后早期拔出导管，可能导致死亡。在猪模型中，手术前洗胃不会改变手术时引入的腹腔内细菌负荷或随后的感染结果。这些令人担忧的发现需要进一步的研究，以确定猪模型是否适合并适用于NOTES环境中的人类受试者。
Background: Obtaining reliable closure of transvisceral defects currently limits natural orifice transluminal endoscopic Surgery (NOTES). PEG tubes are potential means of managing NOTES gastrotomies.Objective: To determine the efficacy of PEG closure after NOTES.Design: An experimental animal studySetting: A laboratoryInterventions: The pigs received gastric lavage with saline solution, chloramphenicol, or no lavage, and then underwent transgastric NOTES peritoneoscopy. Cultures were obtained by endoscopy during the surgery. A sterile foreign body was left in the peritoneal cavity The gastrotomy was closed with a 20F PEG tube. The animals were observed for 14 days and underwent sterile laparotomy. Cultures of the foreign body and the peritoneal cavity were obtained.Main Outcome Measurements: Abscess rate, peritoneal quantitative Cultures.Results: After I exclusion for anesthetic complications, 19 animals underwent NOTES; 18 (94.7%) survived the entire postoperative period. One animal died on postoperative day 2 after the PEG tube dislodged. At 14 days, 5 animals (27.8%) had intra-abdominal abscesses, 8 (44.4%) had positive peritoneal cultures, and 9 (50%) foreign bodies were contaminated on culture. Infectious complications were not altered by the type of gastric lavage or peritoneal bacterial inoculum introduced at the time of surgeryLimitation: Art animal model.Conclusions: PEG Closure of a NOTES gastrotomy is associated with subclinical intra-abdominal abscess formation and can result in death when the tube is dislodged during the early postoperative period. Preprocedural gastric lavage does not alter the intra-abdominal bacterial burden introduced at the time of surgery or subsequent infectious outcomes in the porcine model. These concerning findings necessitate additional studies to determine if porcine models are appropriate and applicable to human Subjects in the NOTES setting.