Ozmen M M, Cöl C, Aksoy A M, Tekeli F A, Berberoglu M
Surgical Department, Numune Hospital, Ankara, Turkey.
Surg Endosc. 1999 Aug;13(8):801-3. doi: 10.1007/s004649901103.
The widespread adoption of the laparoscopic approach has created some concern over the potential for increased risk of bacteremia and sepsis due to increased intraabdominal pressure in patients with intraabdominal infection and peritonitis. This study examines the effect of the CO(2) pneumoperitoneum on bacteremia and bacterial translocation.
New Zealand white rabbits were assigned into three groups of 10 animals. In group 1, 100 ml of sterile saline was infused into the peritoneal cavity under 10 mmHg CO(2) insufflation for 1 h. Group 2 received 100 ml of saline containing 10(9) CFU/ml (colony-forming units) E. coli strain 0163 and 10 mmHg CO(2) insufflation for 1 h. Group 3 received an identical bacterial inoculum, followed by a 10-cm midline laparotomy. Blood samples were taken for culture by cardiac puncture at various intervals during the experiment. At 6 h after being subjected to the experimental procedures, the rabbits were killed and their organs were cultured quantitatively for translocating bacteria.
In group 1, neither blood nor organ cultures were positive, whereas in group 2 all blood cultures became positive in 1 h, and intraperitoneally infused bacteria translocated to the lung and kidney in all rabbits. In group 3, blood cultures became positive in 1 h, all but two of the rabbits had translocated bacteria in their lungs, and kidney samples from two of the rabbits were culture-positive.
Our results indicate that both CO(2) pneumoperitoneum and laparotomy increase the incidence of bacterial translocation from the peritoneal cavity into the bloodstream. Thus, the risk of translocation to extraperitoneal organs such as lung and kidney is increased significantly by laparoscopy. Therefore, laparoscopic surgery should be avoided or used cautiously in the setting of acute peritonitis.
腹腔镜手术方法的广泛应用引发了一些担忧，即腹腔内感染和腹膜炎患者因腹内压升高，菌血症和脓毒症风险可能增加。本研究探讨二氧化碳气腹对菌血症和细菌移位的影响。
将新西兰白兔分为三组，每组10只。第1组在10 mmHg二氧化碳气腹状态下向腹腔内注入100 ml无菌生理盐水，持续1小时。第2组接受100 ml含10⁹CFU/ml（菌落形成单位）大肠杆菌0163菌株的生理盐水，并在10 mmHg二氧化碳气腹状态下持续1小时。第3组接受相同的细菌接种，随后进行10 cm中线剖腹手术。在实验过程中的不同时间间隔通过心脏穿刺采集血样进行培养。在接受实验操作6小时后，处死兔子，并对其器官进行定量培养以检测移位细菌。
第1组血培养和器官培养均为阴性，而第2组所有血培养在1小时内均呈阳性，且所有兔子腹腔内注入的细菌均移位至肺和肾脏。第3组血培养在1小时内呈阳性，除两只兔子外，所有兔子的肺内均有移位细菌，且两只兔子的肾脏样本培养呈阳性。
我们的结果表明，二氧化碳气腹和剖腹手术均会增加细菌从腹腔移位至血流的发生率。因此，腹腔镜检查会显著增加移位至肺和肾脏等腹膜外器官的风险。所以，在急性腹膜炎情况下应避免或谨慎使用腹腔镜手术。
