经胃自然腔道内镜手术中聚维酮碘溶液灌洗胃腔预防感染的临床研究  

Prevention of infection by betadine irrigation of stomach during natural orifice transluminal endoscopic surgery

作　　者：郑永志[1] 王东[1] 李兆申[1] 孔祥毓[1] 龚燕芳[1] 陈丹磊[2] 杨丽[1] 吴仁培[1] 

机构地区：[1]第二军医大学附属长海医院消化内科,上海200433 [2]第二军医大学附属长海医院普外科,上海200433

出　　处：《中华消化内镜杂志》2013年第10期564-568,共5页Chinese Journal of Digestive Endoscopy

摘　　要：目的评估聚维酮碘溶液灌洗胃腔在经胃自然腔道内镜手术（NOTES）感染预防中临床应用的安全性和有效性。方法以2009年3月至2010年6月行经胃NOTES的9位患者为研究对象，手术在腹腔镜手术室进行。随灭菌胃镜置入灭菌外套管，留取胃腔内液5ml（标本A）；吸净胃液，聚维酮碘溶液（聚维酮碘50g/L）200—300ml喷洒灌洗，维持5min后，留取灌洗液5ml（标本B）；经胃NOTES进行腹腔内手术操作后，留取腹腔抽取物5ml（标本C）。标本分别送检细菌培养及鉴定。术后置人胃管胃肠减压，抗炎、抑酸及补液支持处理，观察患者术后反应。结果所有患者均完成经胃内镜腹腔内手术，5例有不同程度的腹腔镜辅助。标本A2例培养阴性，7例阳性，细菌以肠道细菌为主；菌落计数平均为35．6×10^3CFU／ml。标本B和标本C细菌培养9例均为阴性。大部分患者术后无畏寒发热、恶心呕吐、明显腹胀腹痛等不适；术后血生化检查未见异常。术后1周复查胃镜，胃肠壁均无炎症、溃疡、出血等并发症，胃肠道切口止血夹闭合可，未见明显的渗漏等。所有患者术后随访6个月，均未出现感染等手术并发症。结论临床使用聚维酮碘溶液灌洗胃腔预防经胃NOTES感染是安全可行和有效的，当然，进一步临床研究评估其安全性有效性仍是必需的。Objective To study the safety and effect of betadine irrigation of stomach for preventing infection during natural orifice transluminal endoscopic surgery （NOTES）. Methods The clinical data of 9 patients receiving transgastric NOTES at our center from March 2009 to June 2010 were reviewed. After general anesthesia, the stomachs were lavaged with 200 to 300 ml betadine. Then the endoscope was maneu- vered in the peritoneal cavity after the creation of the gastronomy, and some procedures were performed with assistance of laparoscope. A total of 5 ml stomach fluid was collected before and after lavage, and 5 ml of peritoneal fluid was collected at the end of the procedure. At last the gastronomy was closed with clips. Fol- low-up endoscopy was performed 1 week and 6 months after NOTES, respectively. Results All the surgical procedures were performed successfuliy, 5 of which under aid of laparoscope. The gastric fluid collected be- fore lavage was negative for bacteria in 2 patients, and enteric bacilli was the main bacteria in the stomach fluid of other 7 patients, with an average bacterial load of 35.6 ×10^3 CFU/ml. No bacteria was cultured in gastric fluid after lavage and peritoneal fluid after NOTES. No inflammation, ulcer or bleeding was observed under endoscopy 1 week after NOTES. No surgical complications including infection occurred in 6 months after NOTES. Conclusion Betadine irrigation of stomach is safe and effective for preventing infection during NOTES. Further studies are needed for assessing the effectiveness and safety of betadine irrigation in NOTES.

关 键 词：感染 经自然腔道内镜手术 聚维酮碘 经胃路径 临床方案 

分 类 号：R656.61[医药卫生—外科学]