Transgastric instrumentation and bacterial contamination of the peritoneal cavity
Transgastric instrumentation and bacterial contamination of the peritoneal cavity
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DOI：
10.1007/s00464-007-9661-6
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发表时间：
2008-03-01
影响因子：
3.1
通讯作者：
Melvin, W. Scott
中科院分区：
文献类型：
--
作者：
Narula, Vimal K.;Hazey, Jeffrey W.;Melvin, W. Scott
简介 自然孔腔内窥镜手术 (NOTES) 是一种快速发展的技术，可利用内窥镜通过自然孔口进入腹膜。该技术最重要的要求之一是需要最大限度地减少临床上显着的腹膜污染的风险。我们报告了需要进行胃切开术 Roux-en-Y 胃旁路术 (LSRYGB) 的患者腹膜腔的细菌负荷和污染情况。方法 我们前瞻性地研究了 50 名接受胃切开术的患者，并在 LSRYGB 期间进行了胃空肠造口术。我们在术前记录了患者质子泵抑制剂（PPI）的使用情况，并在不进行灌洗的情况下对胃内容物进行了取样。我们还在胃切开术之前和之后对腹膜液进行了采样，记录胃切开术向腹膜开放的时间长度。三个样本均送去进行菌落计数和菌种鉴定。结果 50 名患者接受了 LSRYGB，平均手术时间为 93 分钟。胃切开术向腹膜腔开放平均 18 分钟。 50 名患者中有 17 名术前服用 PPI，导致胃造口术后腹膜细菌计数存在显着差异。胃吸出物的平均菌落形成单位 (CFU) 数为 22,303 CFU/ml。在进行胃切开术之前进行检查的腹膜抽吸物显示，50 名患者中有 44 名没有 CFU。胃切开术后腹膜取样显示腹部污染平均为 1102 CFU/ml。胃切除术后胃中的细菌负荷与腹膜负荷之间没有相关性。未出现感染性并发症或渗漏。一名没有腹膜细菌污染的患者出现了横纹肌溶解症的一种并发症。 结论 经胃器械确实会污染腹腔，但由于种类或细菌负荷，病原体在临床上并不显着。服用 PPI 的患者胃吸出物中的细菌载量确实有所增加，但没有临床意义的感染。
Introduction Natural orifice transluminal endoscopic surgery (NOTES) is a rapidly evolving technique providing access to the peritoneum utilizing an endoscope via a natural orifice. One of the most significant requirements of this technique is the need to minimize the risk of clinically significant peritoneal contamination. We report the bacterial load and contamination of the peritoneal cavity in patients requiring a gastrotomy Roux-en-Y gastric bypass (LSRYGB).Methods We prospectively studied 50 patients undergoing a gastrotomy with creation of a gastrojejunostomy during LSRYGB. We recorded the patient's proton-pump inhibitor (PPI) utilization preoperatively and sampled gastric contents without lavage. We also sampled peritoneal fluid prior to and after gastrotomy, noting the length of time the gastrotomy was open to the peritoneum. Each of the three samples was sent for bacterial colony counts, and culture with identification of species.Results Fifty patients underwent LSRYGB with a mean operative time of 93 min. The gastrotomy was open to the peritoneal cavity for an average of 18 min. Seventeen of 50 patients were on PPIs preoperatively, resulting in a significant difference in postgastrostomy peritoneal bacterial counts. The average number of colony-forming units (CFU) of the gastric aspirate was 22,303 CFU/ml. Peritoneal aspirates obtained for examination prior to creation of a gastrotomy showed no CFUs in 44 of 50 patients. Peritoneal sampling after gastrotomy showed contamination of the abdomen with an average of 1102 CFU/ml. There was no correlation between the bacterial load in the stomach and peritoneal load after gastrotomy. No infectious complications or leaks developed. One complication of rhabdomyolysis in a patient with no peritoneal bacterial contamination developed.Conclusions Transgastric instrumentation does contaminate the abdominal cavity but pathogens are clinically insignificant due to species or bacterial load. Patients on PPIs do have an increased bacterial load in the gastric aspirate, with no clinical significant infection.