经直肠自然腔道内镜手术后腹腔感染分析  

Analysis of peritoneal infection after transrectal natural orifice transluminal endoscopic surgery approach

作　　者：唐静[1] 沈文拥[1] 杨丹[1] 易志强 薛焱[1] 吴涛[1] 刘爱民[1] TANG Jing;SHEN Wenyong;YANG Dan;YI Zhiqiang;XUE Yan;WU Tao;LIU Aimin(Department of Gastroenterology,Fuling Central Hospital,Chongqing 408099,China)

机构地区：[1]重庆市涪陵中心医院消化科

出　　处：《重庆医学》2019年第23期4050-4053,共4页Chongqing medicine

基　　金：重庆市涪陵区科技计划项目科研课题（FLKW,2017ABB1045）

摘　　要：目的 探讨经自然腔道内镜手术(NOTES)直肠入路保胆取石术的安全性、可行性及优势。方法 选取2017年6月至2018年12月于该院行保胆取石手术的患者,依据不同入路方式分为对照组及观察组(各10例),观察组依据术中对降结肠以下肠管不同消毒方法再分为观察组1(5例,术前采用0.9%氯化钠溶液600mL冲洗),观察组2(5例,术前采用甲硝唑600mL反复冲洗)。对照组给予腹腔镜下保胆取石术,观察组给予NOTES直肠入路保胆取石,比较术前、术后及组间白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平;同时手术前后对腹腔抽取物行细菌培养;对比术后并发症及其他临床指标。结果 对照组与两观察组术后1、48hTNF-α水平较术前均明显上升(P<0.05),术后48hTNF-α水平明显低于术后1h(P<0.05),两观察组与对照组术后1、48hTNF-α水平无明显差异(P>0.05);对照组与两观察组术后1、48hIL-6水平较术前均明显上升(P<0.05),术后48h明显高于术后1h(P<0.05);两观察组与对照组术后1、48hIL-6水平无明显差异(P>0.05)。术前、术后腹腔抽取物培养均阴性,术后均未出现发热;术后24h两观察组与对照组白细胞计数无明显差异(P<0.05);对照组与观察组术后均有2例出现腹膜炎体征;对照组腹痛评分明显高于两观察组(P<0.05)。结论 NOTES直肠入路保胆取石无临床显著性污染危险,是一种安全的进入腹腔的替代方法。Objective To investigate the safety,feasibility and advantages of the transrectal natural orifice transluminal endoscopic surgery(NOTES)approach for gallstone removal.Methods Patients who underwent gallbladder stone removal surgery from June 2017 to December 2018 in this hospital were selected and divided into the control group and the observation group according to different approaches,10 cases in each group.According to different disinfection methods of the lower intestinal colon during operation,the observation group was divided into the observation group 1(5 cases,pre-treatment with 0.9%sodium chloride solution 600 mL)and the observation group 2(5 cases,the intestinal lumen was washed repeatedly by using metronidazole 600 mL).The control group received laparoscopic gallstone removal,and the observation group was given the transrectal natural NOTES approach for gallstone removal.The levels of interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)before and after surgery were compared between the groups.Meanwhile,bacterial culture was performed on the abdominal cavity before and after operation,postoperative complications and other clinical indicators were compared,as well.Results After operation,the levels of TNF-αin the control group and the two observation groups were increased significantly(P<0.05),and the level of TNF-αwhen at 48 h after operation were significantly lower than those at 1 h after operation(P<0.05).There was no significant difference in the level of TNF-αwhen compared the two observation groups with the control group at 1,48 h after operation(P>0.05).After operation,the levels of IL-6 in the control group and the two observation groups were increased significantly(P<0.05),and the level of IL-6 at 48 h after operation were significantly higher than those at 1 h after operation(P<0.05).There was no significant difference in the level of TNF-αwhen compared the two observation groups with the control group at 1,48 h after operation(P>0.05).Preoperative and postoperative abdominal cavity cul

关 键 词：腹腔感染 自然腔道内镜手术 腹腔镜 

分 类 号：R657.42[医药卫生—外科学]