Transgastric endoscopic peritoneoscopy does not require decontamination of the stomach in humans
Transgastric endoscopic peritoneoscopy does not require decontamination of the stomach in humans
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DOI：
10.1007/s00464-008-0161-0
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发表时间：
2009-06-01
影响因子：
3.1
通讯作者：
Hazey, Jeffrey W.
中科院分区：
文献类型：
--
作者：
Narula, Vimal K.;Happel, Lynn C.;Hazey, Jeffrey W.
自然孔腔内窥镜手术（NOTES）是一个快速发展的领域，可通过自然孔口提供内窥镜进入腹膜的通道。这项技术的一个重要要求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 10 名接受诊断性经胃内窥镜腹腔镜检查的患者的腹膜腔细菌载量和污染情况。参与该试验的患者计划接受诊断性腹腔镜检查，以评估推测的胰腺癌。将诊断性腹腔镜检查的结果与诊断性经胃内窥镜腹膜镜检查的结果进行比较，使用口服胃镜，使内窥镜医师对腹腔镜检查结果视而不见。我们没有进行胃部净化。记录诊断结果、手术时间和临床病程。在胃切开术之前和之后获得胃镜和腹膜液抽吸物。每个样本均被送去进行菌落计数、培养和菌种鉴定。 10 名患者（平均年龄 63.7 岁）已完成方案。所有患者均接受诊断性腹腔镜检查，然后成功进行经胃入路和诊断性腹膜镜检查。腹腔镜检查的平均时间为 7.2 分钟，而经胃器械的平均时间为 18 分钟。对所有十名患者进行了细菌取样。胃镜抽吸物中的菌落形成单位 (CFU) 平均数为 132.1 CFU/ml，胃切开术前的腹膜抽吸物显示为 160.4 CFU/ml，胃切开术后腹膜取样的平均菌落形成单位数为 642.1 CFU/ml。腹膜腔没有被从胃镜抽吸物中分离出的物质污染。 30 天的随访中未发现感染性并发症或渗漏。人体经胃内窥镜器械安装后，胃镜下的腹膜腔没有出现临床上显着的污染。经胃器械确实会污染腹腔，但病原体在种类或细菌负荷方面不会产生临床上显着的反应。
Natural orifice translumenal endoscopic surgery (NOTES) is a rapidly evolving field that provides endoscopic access to the peritoneum via a natural orifice. One important requirement 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 ten patients who underwent diagnostic transgastric endoscopic peritoneoscopy.Patients participating in this trial were scheduled to undergo diagnostic laparoscopy for evaluation of presumed pancreatic cancer. Findings at diagnostic laparoscopy were compared with those of diagnostic transgastric endoscopic peritoneoscopy, using an orally placed gastroscope, blinding the endoscopist to the laparoscopic findings. We performed no gastric decontamination. Diagnostic findings, operative times, and clinical course were recorded. Gastroscope and peritoneal fluid aspirates were obtained prior to and after the gastrotomy. Each sample was sent for bacterial colony counts, culture, and identification of species.Ten patients, with an average age of 63.7 years, have completed the protocol. All patients underwent diagnostic laparoscopy followed by successful transgastric access and diagnostic peritoneoscopy. The average time for laparoscopy was 7.2 min, compared with 18 min for transgastric instrumentation. Bacterial sampling was obtained in all ten patients. The average number of colony-forming units (CFU) in the gastroscope aspirate was 132.1 CFU/ml, peritoneal aspirates prior to creation of a gastrotomy showed 160.4 CFU/ml, and peritoneal sampling after gastrotomy had an average of 642.1 CFU/ml. There was no contamination of the peritoneal cavity with species isolated from the gastroscope aspirate. No infectious complications or leaks were noted at 30-day follow-up.There was no clinically significant contamination of the peritoneal cavity from the gastroscope after transgastric endoscopic instrumentation in humans. Transgastric instrumentation does contaminate the abdominal cavity but, the pathogens do not mount a clinically significant response in terms of either the species or the bacterial load.