McGee Michael F, Marks Jeffrey M, Onders Raymond P, Chak Amitabh, Rosen Michael J, Williams Christina P, Jin Judy, Schomisch Steve J, Ponsky Jeffrey L
Department of Surgery, Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA.
Gastrointest Endosc. 2008 Aug;68(2):310-8. doi: 10.1016/j.gie.2007.11.054. Epub 2008 Apr 14.
Obtaining reliable closure of transvisceral defects currently limits natural orifice transluminal endoscopic surgery (NOTES). PEG tubes are potential means of managing NOTES gastrotomies.
To determine the efficacy of PEG closure after NOTES.
An experimental animal study.
A laboratory.
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.
Abscess rate, peritoneal quantitative cultures.
After 1 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 surgery.
An animal model.
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.
目前，实现经内脏缺损的可靠闭合限制了自然腔道内镜手术（NOTES）的发展。经皮内镜下胃造口术（PEG）管是处理NOTES胃切开术的潜在手段。
确定NOTES术后PEG闭合的疗效。
一项实验动物研究。
实验室。
给猪用生理盐水、氯霉素进行洗胃，或不进行洗胃，然后进行经胃NOTES腹腔镜检查。手术期间通过内镜获取培养物。在腹腔内留置一个无菌异物。用20F的PEG管闭合胃切开术。观察动物14天，然后进行无菌剖腹手术。获取异物和腹腔的培养物。
脓肿发生率、腹腔定量培养。
排除1例麻醉并发症后，19只动物接受了NOTES手术；18只（94.7%）存活至术后整个观察期。1只动物在PEG管脱出后于术后第２天死亡。14天时，5只动物（27.8%）发生腹腔内脓肿，8只（44.4%）腹腔培养阳性，9个（50%）异物培养有污染。手术时的洗胃类型或引入的腹腔细菌接种量并未改变感染并发症的发生情况。
动物模型。
NOTES胃切开术采用PEG闭合与亚临床腹腔内脓肿形成有关，且术后早期PEG管脱出时可导致死亡。术前洗胃并未改变猪模型中手术时引入的腹腔细菌负荷或随后的感染结局。这些令人担忧的发现需要进一步研究，以确定猪模型在NOTES环境中是否适用于人类受试者。
