Department of General Surgery, Qilu Hospital, Shandong University, Jinan, Shandong, China.
Chin Med J (Engl). 2011 Feb;124(4):556-61.
The infection risk of natural orifice transluminal endoscopic surgery (NOTES) is of concern. The aim of this study was to assess the safety of NOTES by investigating the intraperitoneal bacterial load during transgastric and transvaginal procedures with antiseptic or controlling perioperative preparation.
Forty-five female pigs were randomly assigned to five equal groups: the transgastric (TG) control group (group A), the TG middle volume gastric lavage group (group B), the TG high volume lavage group (group C), the transvaginal (TV) control group (group D) and the TV study group (group E). The study groups received gastric or vaginal lavage and abdominal antimicrobial irrigation, while the control groups received neither. All animals were administered intravenous antibiotics, underwent NOTES peritoneoscopy and transumbilical laparoscopic cholecystectomy under NOTES view with sterile instruments. The viscerotomy was closed by laparoscopic suture. The animals were observed until necropsy was performed 14 days postoperatively. Quantitative bacteriologic cultures were taken from the gastric or vaginal aspirate before and after lavage; peritoneal fluid was collected before and after peritoneal irrigation and at necropsy.
The surgical procedures were completed for all the pigs and all of them survived. The mean operative time of the TG group and the TV group was (81 ± 27) minutes and (66 ± 12) minutes, respectively. All animals survived for 14 days. At necropsy, significantly more peritoneal infections were noted in group A than in group D (5:9 vs. 0:9; P < 0.05). No gross evidence of intra-peritoneal infection was found in groups B, C, D and E. Bacteriological evidence was seen in all pigs in group A, 7 pigs in group B, 6 pigs in group D, and none in groups C and E.
Without gastric or vaginal lavage and antibiotic peritoneal irrigation, the TG procedure has a higher infection rate than the TV access. After antiseptic preparation, the bacterial load significantly decreased in the TG group, which seems as safe as the sterile TV approach.
经自然腔道内镜手术（NOTES）的感染风险令人担忧。本研究旨在通过调查经胃和经阴道手术时的腹腔内细菌负荷，评估 NOTES 的安全性，这些手术分别采用了消毒或控制围手术期准备。
45 头雌性猪随机分为五组，每组 9 头：经胃（TG）对照组（A 组）、TG 中容量胃灌洗组（B 组）、TG 高容量灌洗组（C 组）、经阴道（TV）对照组（D 组）和 TV 研究组（E 组）。研究组接受胃或阴道灌洗和腹腔抗菌灌洗，而对照组则不进行任何处理。所有动物均给予静脉抗生素，在 NOTES 视线下使用无菌器械进行 NOTES 腹腔镜检查和经脐腹腔镜胆囊切除术。剖腹切口通过腹腔镜缝合关闭。所有动物观察至术后 14 天行尸检。在灌洗前后分别从胃抽吸液或阴道抽吸液中进行定量细菌培养；在腹腔灌洗前后和尸检时采集腹腔液。
所有猪均完成手术，且全部存活。TG 组和 TV 组的平均手术时间分别为（81±27）分钟和（66±12）分钟。所有动物均存活 14 天。尸检时，A 组的腹腔感染明显多于 D 组（5/9 比 0/9；P<0.05）。B、C、D 和 E 组均未见明显腹腔内感染的大体证据。A 组所有猪、B 组 7 头猪、D 组 6 头猪均有细菌学证据，C 组和 E 组均无细菌学证据。
不进行胃或阴道灌洗和抗生素腹腔灌洗时，TG 操作的感染率高于 TV 入路。经过消毒准备后，TG 组的细菌负荷明显减少，其安全性与无菌 TV 方法相当。
