Center for Minimally Invasive Surgery, The Ohio State University School of Medicine and Public Health, 410 West 10th Avenue, Columbus, OH 43210-1228, USA.
Surg Endosc. 2011 Jul;25(7):2186-91. doi: 10.1007/s00464-010-1521-0. Epub 2011 Feb 7.
It remains important to determine the risk of bacterial contamination and infectious complications of the peritoneal cavity as it pertains to transgastric natural orifice translumenal endoscopic surgery (NOTES) procedures. The infectious implications of such procedures have been quantified in animal models. This report discusses the infectious risks of transgastric endoscopic peritoneoscopy (TEP) in a human clinical trial.
Under institutional review board approval, 40 patients scheduled for laparoscopic Roux-en-Y gastric bypass (LRYGB) participated in this study. The TEP procedure was performed without preoperative gastric decontamination and without laparoscopic guidance. Preoperative intravenous antibiotics were given. Saline aspirates were taken from the gastric lumen before endoscopic gastrotomy creation and from the peritoneal cavity after transgastric access. Samples were sent for culture, identification, and bacterial counts. Subgroup analysis was performed on patients taking proton pump inhibitors (PPIs). These data were compared with data for "sterile" peritoneal aspirates from a historical cohort of 50 patients undergoing LRYGB.
The median number of bacteria isolated from the gastric aspirates was 980 colony-forming units (CFU)/ml (n=40). The median number of bacteria isolated from the peritoneal aspirates was 323 CFU/ml. Cross-contamination from the stomach to the peritoneal cavity was documented in eight cases. No abscesses or anastomotic leaks were recorded. One port-site infection occurred. Subgroup analysis of 15 patients receiving PPIs showed elevated bacterial counts in gastric aspirates and the post-TEP peritoneal samples compared with patients not receiving PPIs (n=25). This subgroup on PPI's did not have an increase in infectious complications.
Contamination of the peritoneal cavity does occur with TEP, but this does not lead to an increased risk of infectious complications. Similarly, patients receiving PPIs have an increased gastric bacterial load and increased contamination after TEP but not an increased risk of infectious complications.
确定经胃自然腔道内镜外科（NOTES）手术相关的腹腔细菌污染和感染并发症的风险仍然很重要。此类手术的感染影响已在动物模型中得到量化。本报告讨论了人体临床试验中经胃内镜腹膜检查（TEP）的感染风险。
在机构审查委员会的批准下，40 名计划行腹腔镜 Roux-en-Y 胃旁路术（LRYGB）的患者参与了本研究。TEP 手术在没有术前胃去污和没有腹腔镜引导的情况下进行。术前给予静脉内抗生素。在创建内镜胃造口术之前从胃腔中抽取盐水抽吸物，并在经胃进入后从腹腔中抽取盐水抽吸物。将样本送去培养、鉴定和细菌计数。对服用质子泵抑制剂（PPIs）的患者进行亚组分析。将这些数据与 50 名接受 LRYGB 的历史队列患者的“无菌”腹膜抽吸数据进行比较。
从胃抽吸物中分离出的细菌中位数为 980 个菌落形成单位（CFU）/ml（n=40）。从腹膜抽吸物中分离出的细菌中位数为 323 CFU/ml。在 8 例中记录到从胃到腹腔的交叉污染。没有记录到脓肿或吻合口漏。发生 1 例端口部位感染。接受 PPI 治疗的 15 名患者的亚组分析显示，与未接受 PPI 治疗的患者（n=25）相比，胃抽吸物和 TEP 后腹膜样本中的细菌计数升高。接受 PPI 的这一组患者并没有增加感染并发症的风险。
TEP 确实会导致腹膜腔污染，但这并不会增加感染并发症的风险。同样，接受 PPI 治疗的患者在 TEP 后胃内细菌负荷和污染增加，但感染并发症的风险没有增加。
