聚维酮碘溶液灌洗胃肠道预防经自然腔道内镜手术感染的实验研究.pdfVIP

聚维酮碘溶液灌洗胃肠道预防经自然腔道 内镜手术感染的实验研究 郑永志 王东 顾俊骏 龚燕芳 吴仁培 李兆申 [摘要] 目的 评价聚维酮碘溶液灌洗胃肠道在经自然腔道内镜手术(NOTES)的感染预防中 的可行性和有效性。方法 采用12只雌性家猪模型。对照组4只仅用生理盐水500 ml灌洗胃肠道； 实验组8只先用生理盐水500 ml灌洗胃肠道,再用聚维酮碘溶液200 ml灌洗胃肠道。对照组及实验 组均在经胃或结肠途径时先留取胃肠道液5ml,在生理盐水或聚维酮碘溶液灌洗后再留取灌洗液 5ml,最后在NOTES完成后留取腹腔抽取物5 ml,标本分别送检进行细菌培养及鉴定。术后24h复 查内镜观察胃肠道有无炎症、溃疡、出血等。术后3周处死并解剖动物,观察腹腔内有无粘连、脓肿等 感染情况。结果 除实验组1例出现膈肌损伤死亡外,11例成功存活至3周后处死解剖。经胃途径 的灌洗前细菌负荷平均为17.5×103 CFU/ml,对照组生理盐水灌洗后平均为2.5×103 CFU/ml,术后 平均为5.5×103 CFU/ml；实验组聚维酮碘灌洗后细菌负荷平均为0 CFU/ml,术后平均为7.5 CFU/ml。 经结肠途径的灌洗前细菌负荷平均为76.2×103 CFU/ml,对照组生理盐水灌洗后平均为19.5× 103 CFU/ml,术后平均为21×103 CFU/ml;实验组聚维酮碘灌洗后细菌负荷平均为2.25×103 CFU/ml, 术后平均为1×103 CFU/ml。术后24h复查内镜胃肠道均未见炎症、溃疡、出血等。3周后处死动物解 剖发现对照组粘连、脓肿等多于实验组；实验组中仅有经结肠途径1例出现粘连。结论 使用聚维酮碘 溶液灌洗胃肠道预防NOTES感染是可行和有效的,但还需进一步临床研究评估其安全性有效性。 经自然腔道内镜手术；家猪；经胃路径；经结肠路径；聚维酮碘；实验研究 Betadine solution irrigation of gastrointestinal tract for infection prevention during natural orifice transluminal endoscopic surgery ZHENG Yong-zhiWANG DongGU Jun-junGONG Yan-fangWU Ren-peiLI Zhao-shenDepartment of Gastroenterology, Changhai Hospital, Second Military Medical Univer sity , Shanghai 200433, China [ Abstract] Objective To evaluate the feasibility and efficacy of betadine solution irrigation of gas trointestinal tract for infection prevention during the procedure of natural orifice transluminal endoscopic sur gery (NOTES). Methods Twelve female porcine were divided into control group ( n = 4) to receive lavage with 500 ml normal saline and experimental group (n = 8) to undergo lavage with 500 ml normal saline fol lowed by 200 ml betadine solution. Fluid from gastrointestinal tract (5 ml) were collected before and after lavage, and after NOTES for culture. Endoscopy was performed 24 hours after NOTES to observe possible ex istence of inflammation, ulcer or bleeding. The animals were sacrificed 3 weeks after NOTES to explore in tra-peritoneal adhesions, abscesses and other infections. Results One swine died of diaphra