Abdominal Surgery in Patients With COVID-19 Detection of SARS-CoV-2 in Abdominal and Adipose Tissues
Abdominal Surgery in Patients With COVID-19 Detection of SARS-CoV-2 in Abdominal and Adipose Tissues
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DOI：
10.1097/sla.0000000000004165
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发表时间：
2020-09-01
影响因子：
9
通讯作者：
Aminian, Ali
中科院分区：
文献类型：
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作者：
Safari, Saeed;Keyvani, Hossein;Aminian, Ali
我们在 4 名 2019 年冠状病毒病 (COVID-19) 患者的紧急腹部手术中获取了多个组织样本，以检查严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 是否参与组织。第一位患者因胆囊脓胸接受腹腔镜胆囊切除术，并因严重呼吸衰竭死亡。第二名克罗恩病患者因回肠末端穿孔接受紧急剖腹手术并康复。第三名患者接受了开放式阑尾切除术并康复。第四名患者因消化性溃疡穿孔而接受紧急剖腹手术，并死于败血症。尽管在3名患者的粪便和消化性溃疡穿孔患者的十二指肠壁中发现了SARS-CoV-2 RNA，但腹液的实时逆转录聚合酶链反应（RT-PCR）检查结果为病毒阴性。 RT-PCR未在小肠壁、阑尾、胆囊、胆汁、肝脏和尿液中检测到病毒RNA。 4名患者的内脏脂肪（大网膜）和腹部皮下脂肪也未感染SARS-CoV-2。尽管这一有限的经验并未显示腹腔液和大网膜的直接参与，但建议进行大规模评估，以提供有关 COVID-19 患者腹部手术安全性的答案。
Multiple tissue samples were obtained during emergent abdominal surgery in 4 patients with coronavirus disease 2019 (COVID-19) to examine for tissue involvement by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first patient underwent a laparoscopic cholecystectomy for gallbladder empyema and died from severe respiratory failure. The second patient with Crohn disease underwent emergent laparotomy for a perforation in the terminal ileum and recovered. The third patient underwent an open appendectomy and recovered. The fourth patient underwent emergent laparotomy for a perforated peptic ulcer and died from sepsis. Although the SARS-CoV-2 RNA was found in the feces of 3 patients and in the duodenal wall of the patient with perforated peptic ulcer, real time reverse transcriptase polymerase chain reaction (RT-PCR) examination of abdominal fluid was negative for the virus. The RT-PCR did not detect viral RNA in the wall of small intestine, appendix, gallbladder, bile, liver, and urine. Visceral fat (omentum) and abdominal subcutaneous fat of 4 patients were also not infected with the SARS-CoV-2. Although this limited experience did not show direct involvement of abdominal fluid and omentum, assessment in large series is suggested to provide answers about the safety of abdominal surgery in patients with COVID-19.