Agalar F, Sayek I, Agalar C, Cakmakçi M, Hayran M, Kavuklu B
Department of General Surgery, Hacettepe University School of Medicine, Ankara, Turkey.
Eur J Surg. 1997 Dec;163(12):909-14.
To assess the effect of intraperitoneal gallstones with and without Escherichia coli and sterile bile on the incidence of intraperitoneal complications in mice.
Prospective randomised study.
Teaching hospital, Turkey.
180 Swiss albino mice in five groups, n = 20 in the control group, and n = 40 in each of the experimental groups.
Group A laparotomy alone (controls); group B, laparotomy amd intraperitoneal instillation of E. coli 4 x 10(6) 0.1 ml; group C, laparotomy and insertion of sterilised gallstones; group D, laparotomy, insertion of gallstones and instillation of E. coli 4 x 10(6) 0.1 ml; and group E, laparotomy, insertion of gallstones, and instillation of E. coli 4 x 10(6) 0.1 ml and sterile bile 0.1 ml. A quarter of each group was killed after 1, 2, 4, and 8 weeks.
Intra-peritoneal abscesses, adhesions, perforations, fistula, or obstruction.
No mice died. Adhesions were found in 3(15%), 7(18%), 30(75%), 25(63%), and 24(60%) in the five groups, respectively. No mice in groups A, B, or C developed an abscess, but 8 did in each of groups D and E (20%). One mouse in group D developed obstruction. Logistic regression showed that abscess formation was significantly increased by the addition of gallstones and E. coli to the peritoneal cavity (p < 0.001) but the addition of bile had no effect. Gallstones increased the rate of adhesions more than nine fold (p < 0.001) but E. coli with or without bile had no effect (p = 0.75).
Free gallstones within the peritoneal cavity with or without E. coli or sterile bile, or both, increased the rate of formation of both abscesses and adhesions in mice. These results suggest that efforts should be made retrieve gallstones that are dropped into the peritoneal cavity during laparoscopic cholecystectomy, particularly in patients with acute cholecystitis.
评估有无大肠杆菌及无菌胆汁的腹腔内胆结石对小鼠腹腔内并发症发生率的影响。
前瞻性随机研究。
土耳其的教学医院。
180只瑞士白化小鼠，分为五组，对照组20只，各实验组40只。
A组仅行剖腹术（对照组）；B组，剖腹术并腹腔内注入0.1 ml 4×10⁶的大肠杆菌；C组，剖腹术并植入无菌胆结石；D组，剖腹术、植入胆结石并注入0.1 ml 4×10⁶的大肠杆菌；E组，剖腹术、植入胆结石、注入0.1 ml 4×10⁶的大肠杆菌及0.1 ml无菌胆汁。每组四分之一的小鼠在1、2、4和8周后处死。
腹腔脓肿、粘连、穿孔、瘘管或梗阻。
无小鼠死亡。五组中粘连的发生率分别为3（15%）、7（18%）、30（75%）、25（63%）和24（60%）。A、B或C组无小鼠发生脓肿，但D组和E组各有8只（20%）发生脓肿。D组有1只小鼠发生梗阻。逻辑回归显示，向腹腔内添加胆结石和大肠杆菌会显著增加脓肿形成的发生率（p < 0.001），但添加胆汁无影响。胆结石使粘连发生率增加了九倍多（p < 0.001），但有无胆汁的大肠杆菌均无影响（p = 0.75）。
腹腔内有无大肠杆菌或无菌胆汁或两者皆有的游离胆结石会增加小鼠脓肿和粘连的形成率。这些结果表明，应努力取出腹腔镜胆囊切除术中掉入腹腔的胆结石，尤其是在急性胆囊炎患者中。
