在进行腹腔镜与内镜联合手术时，术前胃生理盐水灌洗对细菌计数的降低作用。
Reduction effect of bacterial counts by preoperative saline lavage of the stomach in performing laparoscopic and endoscopic cooperative surgery.
作者信息
Mori Hirohito, Kobara Hideki, Tsushimi Takaaki, Fujihara Shintaro, Nishiyama Noriko, Matsunaga Tae, Ayaki Maki, Yachida Tatsuo, Tani Joji, Miyoshi Hisaaki, Morishita Asahiro, Masaki Tsutomu
机构信息
Hirohito Mori, Hideki Kobara, Shintaro Fujihara, Noriko Nishiyama, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Joji Tani, Hisaaki Miyoshi, Asahiro Morishita, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan.
出版信息
World J Gastroenterol. 2014 Nov 14;20(42):15763-70. doi: 10.3748/wjg.v20.i42.15763.
AIM
To investigate the effects of gastric lavage with 2000 mL of saline in laparoscopic and endoscopic cooperative surgery.
METHODS
Twenty two patients who were diagnosed with a gastric gastrointestinal stromal tumor were enrolled. In former term, irrigations of the stomach were conducted whenever it was necessary, not systematically (Non systemic lavage group). In latter term, the stomach was thoroughly cleaned with 2000 mL of saline using an endoscope with a water jet, and Duodenal balloon occlusion was conducted to prevent refluxed bile and pancreatic juice (Systemic lavage+balloon occlusion group). The gastric wall was sprayed with 20 mL of distilled water, and 20 mL of gastric juice was collected in a sterile tube and submitted for culture. 20 mL of ascites was also collected from the laparoscopic ports and submitted for culture. We compared WBC, CRP, BT between two groups, and verify the reduction effect of bacterial counts in Systemic lavage+balloon occlusion group.
RESULTS
WBC count before, 1 d after, and 3 d after laparoscopic and endoscopic cooperative surgery (LECS) were 5060 (95%CI: 4250-9640), 12140 (6050-14110), and 6910 (5320-12520) in Non systemic lavage group, 4400 (3660-7620), 8910 (6480-10980), and 5950 (4840-7860) in Systemic lavage+balloon occlusion group. Significant differences between two groups at the day after LECS (P = 0.029) and the 3 d after LECS (P = 0.042). CRP levels in Non systemic lavage group and in Systemic lavage+balloon occlusion group were significantly different at the day after LECS (P = 0.005) and the 3 d after LECS (P = 0.028). BTs (°C) in Non systemic lavage group and in Systemic lavage+balloon occlusion group were also significantly different at the day after LECS (P = 0.004) and the 3 d after LECS (P = 0.006). In a logarithmic comparison, bacterial load before gastric lavage, after lavage, and ascites culture were 6.08 (95%CI: 4.04-6.97), 0.48 (0-0.85), and 0.21 (0-0.56). The bacterial counts before and after gastric lavage were significantly suppressed (P = 0.007), but no significant difference between gastric juice culture after lavage and ascites (P = 0.154).
CONCLUSION
Pre-LECS lavage with 2000 mL of saline exhibited a bacteria-reducing effect equivalent to disinfectants and obtained favorable results in terms of clinical symptoms and data.
目的
探讨在腹腔镜与内镜联合手术中用2000毫升生理盐水洗胃的效果。
方法
纳入22例被诊断为胃胃肠道间质瘤的患者。前期，必要时进行胃冲洗，不进行系统冲洗（非系统冲洗组）。后期，使用带水刀的内镜用2000毫升生理盐水彻底清洗胃，并进行十二指肠球囊封堵以防止胆汁和胰液反流（系统冲洗+球囊封堵组）。向胃壁喷洒20毫升蒸馏水，在无菌试管中收集20毫升胃液并送检培养。还从腹腔镜切口处收集20毫升腹水并送检培养。我们比较了两组之间的白细胞、C反应蛋白、体温，并验证系统冲洗+球囊封堵组细菌计数的降低效果。
结果
非系统冲洗组在腹腔镜与内镜联合手术（LECS）前、术后1天和术后3天的白细胞计数分别为5060（95%CI：4250-9640）、12140（6050-14110）和6910（5320-12520），系统冲洗+球囊封堵组分别为4400（3660-7620）、8910（6480-10980）和5950（4840-7860）。两组在LECS术后1天（P = 0.029）和术后3天（P = 0.042）有显著差异。非系统冲洗组和系统冲洗+球囊封堵组的C反应蛋白水平在LECS术后1天（P = 0.005）和术后3天（P = 0.028）有显著差异。非系统冲洗组和系统冲洗+球囊封堵组的体温（℃）在LECS术后1天（P = 0.004）和术后3天（P = 0.006）也有显著差异。在对数比较中，洗胃前、洗胃后和腹水培养的细菌载量分别为6.08（95%CI：4.04-6.97）、0.48（0-0.85）和0.21（0-0.56）。洗胃前后的细菌计数得到显著抑制（P = 0.007），但洗胃后胃液培养与腹水之间无显著差异（P = 0.154）。
结论
LECS前用2000毫升生理盐水洗胃显示出与消毒剂相当的减少细菌的效果，并且在临床症状和数据方面取得了良好结果。
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