Medical Department C, Klinikum Ludwigshafen gGmbH, Ludwigshafen, Germany.
Endoscopy. 2010 Sep;42(9):748-52. doi: 10.1055/s-0030-1255597. Epub 2010 Jul 28.
Natural-orifice transluminal endoscopic surgery (NOTES) is an emerging transluminal technique in which interventions are carried out by entering the abdominal cavity via a natural orifice such as the stomach. Infection is a potential risk of the procedure, and the potential pathogens are different from those encountered with skin incisions. Currently, available data regarding prophylactic anti-infective treatment are limited. We compared the effectiveness of topical antimicrobial lavage of mouth and stomach and proton pump inhibitor therapy with gastric cleansing with sterile saline solution in preventing NOTES-related contamination and infection.
A randomized survival swine study was performed. Eight pigs underwent preparation with intravenously administered proton pump inhibitors, mouth and gastric lavage (chlorhexidine), and gastric irrigation (diluted neomycin), plus single-shot intravenous antibiotics. Control group (n = 8) underwent gastric cleansing with sterile saline solution. Peritoneal biopsy, multiple smears, and dilutions for cultures were taken and incubated. The swine were sacrificed after 14 days. Bacterial load was expressed in colony-forming units (CFU).
One pig died due to gallbladder perforation after 3 days, 2/15 swine presented minor clinical signs of infection in the 14-day follow-up (all 3 pigs were in the control group). Mean C-reactive protein levels were 5.7 +/- 2.4 g/dL (therapy group) and 12.2 +/- 3.8 g/dL (control) ( P = 0.17). Bacterial growth was seen in 1/8 swine (therapy group) and 6/8 swine (control group) ( P = 0.002). Bacterial load was 282 CFU/mL (therapy) vs. 3.2 x 10 (5) CFU/mL (control) ( P = 0.023) in the follow-up.
The use of intravenous antibiotics in addition to topical antimicrobial lavage of mouth and stomach and treatment with proton pump inhibitors decreased the peritoneal bacterial load to almost zero and this was associated with a significantly lower peritoneal infection rate compared with saline-only lavage.
经自然腔道内镜外科（NOTES）是一种新兴的经腔内镜技术，它通过进入胃等自然腔道进行腹部干预。感染是该手术的潜在风险，潜在病原体与皮肤切口不同。目前，关于预防抗感染治疗的可用数据有限。我们比较了经口和胃局部抗菌冲洗与质子泵抑制剂联合治疗和无菌生理盐水胃灌洗在预防NOTES 相关污染和感染方面的效果。
进行了一项随机生存猪研究。8 头猪接受静脉给予质子泵抑制剂、口胃冲洗（洗必泰）和胃灌洗（稀释新霉素）以及单次静脉注射抗生素预处理。对照组（n = 8）接受无菌生理盐水胃灌洗。进行腹膜活检、多次涂片和培养稀释液培养及孵育。14 天后处死猪。细菌负荷以菌落形成单位（CFU）表示。
1 头猪术后 3 天因胆囊穿孔死亡，14 天随访中有 2/15 头猪出现轻微感染迹象（所有 3 头猪均在对照组）。平均 C 反应蛋白水平为 5.7 ± 2.4 g/dL（治疗组）和 12.2 ± 3.8 g/dL（对照组）（P = 0.17）。8 头猪中有 1 头（治疗组）和 8 头猪中有 6 头（对照组）可见细菌生长（P = 0.002）。在随访中，治疗组细菌负荷为 282 CFU/mL，而对照组为 3.2 x 10（5）CFU/mL（P = 0.023）。
与仅用生理盐水冲洗相比，静脉应用抗生素联合经口和胃局部抗菌冲洗与质子泵抑制剂治疗可将腹膜细菌负荷降低至几乎为零，并且与显著降低的腹膜感染率相关。
