消化内镜超级微创手术创面预处理与抗生素应用专家共识(2023年,北京)  

Chinese expert consensus on wound pretreatment and antibiotic application in endoscopic super minimally invasive surgery(2023,Beijing)

作　　者：无 令狐恩强 柴宁莉 陈倩倩[3] 宁波 吴庆珍 李云奇[3] 邵群 杨伟丽 高飞[3] 

机构地区：[1]中华医学会消化内镜学分会,北京100710 [2]不详 [3]解放军总医院第一医学中心

出　　处：《中华胃肠内镜电子杂志》2023年第2期83-91,共9页Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition)

摘　　要：目的近年,国内外多家医院在超级微创理念下进行了一系列超级微创手术(SMIS),凸显其理念优势。但目前针对该类手术创面预处理和抗生素应用,尚无统一专家共识。本共识是基于可获得的最佳科学证据来探讨消化内镜SMIS创面预处理与抗生素应用的问题。方法本共识从中华医学会消化内镜学分会超级微创协作组、ERCP学组、超声内镜学组、内镜外科学组、消化道早癌协作组、食管疾病协作组、胃疾病协作组、胰腺疾病协作组、消化内镜隧道技术协作组等招募形成专家小组,创建了临床问题列表,并将每个问题分配给专家以产生一个陈述。专家小组通过2022年11月至2023年4月召开的3个线上和线下会议讨论并修改以上陈述,直到取得协商一致意见。最终,将完整的陈述收集并发送给所有专家小组成员,以对证据进行分级,对陈述进行分类,及对陈述的强度进行投票。结果制定了关于消化内镜SMIS四条手术通道下手术创面预处理与抗生素应用的16条陈述,其中手术创面预处理5条,抗生素应用11条。结论关于消化内镜SMIS创面预处理与抗生素应用的共识是所有学会中首次发表的。本共识建议在SMIS的临床实践中,内镜医师应充分考虑不同手术通道的特点,选择不同的创面预处理和抗生素应用方法,同时制定隔离措施、严格消毒内镜、使用一次性无菌器械,以最大程度降低感染发生率。另因多腔隙通道涉及微创外科领域,还应同时遵循外科相关操作流程。Objective In recent years,many hospitals both home and abroad have performed a series of surgeries under the concept of super minimally invasive surgery(SMIS),which highlights the advantages of SMIS.However,there is no expert consensus on wound pretreatment and antibiotic application for this type of surgery.This consensus aims to discuss the issues of wound pretreatment and antibiotic application in digestive endoscopic SMIS based on the best available scientific evidence.Methods Experts were recruited from the Super Minimally Invasive Surgery Group,ERCP Group,Ultrasound Endoscopy Group,Endoscopic Surgery Group,Early Gastrointestinal Cancer Collaborative Group,Esophageal Disease Collaborative Group,Gastric Disease Collaborative Group,Pancreatic Disease Collaborative Group and Endoscopic Tunneling Technology Group of Chinese Society of Digestive Endoscopology to form the expert group and a clinical question list was created.Each question was assigned to experts to form the statements which were then discussed and revised to reach agreement in 3 online and offline meetings between November 2022 and April 2023.Finally,the full statement collection was sent to all expert group members to grade the evidence,classify the statements,and vote on the strength of the statements.Results Sixteen statements on surgical wound pretreatment and antibiotic application in four surgical channels of digestive endoscopic SMIS were formulated,including 5 statements on surgical wound pretreatment and 11 statements on antibiotic application.Conclusions The consensus on wound pretreatment and antibiotic application for digestive endoscopic SMIS is the first published among all societies.This consensus recommends that in the clinical practice of SMIS,endoscopists should fully consider the characteristics of different surgical channels,choose different wound pretreatment and antibiotic application methods,formulate isolation measures,strictly disinfect the endoscope,and use disposable sterile instruments to minimize the incidence of infec

关 键 词：超级微创手术 创面预处理 抗生素应用 共识 

分 类 号：R657.5[医药卫生—外科学]