Sodergren Mikael H, Pucher Philip, Clark James, James David R C, Sockett Jenny, Matar Nagy, Teare Julian, Yang Guang-Zhong, Darzi Ara
Department of Biosurgery and Surgical Technology, Academic Surgical Unit, Imperial College London, St.Mary's Hospital, South Wharf Rd, Paddington W2 1NY, UK.
Diagn Ther Endosc. 2011;2011:245175. doi: 10.1155/2011/245175. Epub 2011 Jul 12.
Introduction. Appropriate prevention of infection is a key area of research in natural orifice translumenal endoscopic surgery (NOTES), as identified by the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR). Methods. A review of the literature was conducted evaluating the evidence base for access orifice preparation/treatment in NOTES procedures in the context of infectious complications. Recommendations based on the Oxford Centre for Evidence-Based Medicine guidelines were made. Results. The most robust evidence includes several experimental randomised controlled trials assessing infectious complications in the transgastric approach to NOTES. Transvaginal procedures are long established for accessing the peritoneal cavity following disinfection with antiseptic. Only experimental case series for transcolonic and transvesical approaches are described. Conclusion. Grade C recommendation requiring no preoperative preparation can be made for the transgastric approach. Antiseptic irrigation is recommended for transvaginal (grade C) NOTES access, as is current practice. Further human trials need to be conducted to corroborate the current evidence base for transgastric closure. It is important that future trials are conducted in a methodologically robust fashion, with emphasis on clinical outcomes and standardisation of enterotomy closure and postoperative therapy.
引言。如自然腔道手术评估与研究联盟（NOSCAR）所指出的，适当预防感染是经自然腔道内镜手术（NOTES）研究的一个关键领域。方法。对文献进行回顾，评估NOTES手术中通道口准备/处理在感染并发症方面的证据基础。依据牛津循证医学中心指南提出建议。结果。最有力的证据包括多项评估经胃NOTES手术感染并发症的实验性随机对照试验。经阴道手术在用消毒剂消毒后进入腹腔已有很长时间。仅描述了经结肠和经膀胱手术的实验性病例系列。结论。对于经胃手术，可做出无需术前准备的C级推荐。经阴道NOTES通道建议采用消毒剂冲洗，这与当前做法一致。需要进行进一步的人体试验以证实经胃闭合的现有证据基础。未来的试验应以方法学严谨的方式进行，重点关注临床结果以及肠切开闭合和术后治疗的标准化，这一点很重要。
