Welsh J D, Griffiths W J, McKee J, Wilkinson D, Flournoy D J, Mohr J A
J Clin Gastroenterol. 1983 Apr;5(2):109-12. doi: 10.1097/00004836-198304000-00003.
The present study was undertaken because the previously reported incidence of bacteremia associated with esophageal dilatation seemed high, and did not correlate well with clinical experience. Seventeen adult patients were dilated for benign esophageal strictures with one to three dilators on 41 occasions. Five blood cultures were taken over the 30-minute period after each dilatation. Either routinely sterilized dilators or dilators resterilized just before the procedure were used in a random fashion. On 22 of the occasions that routinely sterilized dilators were used in 17 patients, temperatures, white blood counts, and blood cultures were normal in each instance. Resterilized dilators were used on 19 occasions in 15 subjects, and postdilation temperatures and white blood counts were also normal. Two blood cultures from different patients grew Staphylococcus epidermidis, which were felt to be contaminants. On the basis of this and previous studies, extra precautions do not appear to be necessary for dilatation of routine benign strictures. In patients at risk for endocarditis, or those with cancer or tight strictures, it seems advisable to sterilize dilators just before use, and take extra precautions.
开展本研究是因为之前报道的与食管扩张相关的菌血症发生率似乎较高，且与临床经验不太相符。17例成年患者因良性食管狭窄接受扩张治疗，共进行了41次扩张，每次使用1至3个扩张器。每次扩张后30分钟内采集5份血培养样本。随机使用常规消毒的扩张器或在操作前重新消毒的扩张器。在17例患者使用常规消毒扩张器的22次操作中，每次的体温、白细胞计数和血培养结果均正常。15例受试者在19次操作中使用了重新消毒的扩张器，扩张后体温和白细胞计数也正常。来自不同患者的两份血培养样本培养出表皮葡萄球菌，认为是污染菌。基于本研究及之前的研究，对于常规良性狭窄的扩张，似乎无需采取额外的预防措施。对于有感染性心内膜炎风险的患者，或患有癌症或狭窄严重的患者，在使用前对扩张器进行消毒并采取额外的预防措施似乎是明智的。
