위암 환자에서 상부위장관내 미생물총

Abstract

Purpose: This study was aimed to identify bacteria what might contaminate peritoneal cavity during gastric cancer surgery and to find the relating factors with the distribution of the bacteria.

Methods: From January 2011 to June 2013, in 91 consecutive patients who underwent open gastrectomy or laparoscopic gastrectomy with extracorporeal anastomosis. Intraluminal contents of esophagus (E-sample, n=40), stomach (S-sample, n=38), or duodenum (D-sample, n=23) were cultured for evaluating species of microflora.

Results: Alpha streptococcus was the most common flora of the three organs (62.5% in esophagus, 31.6% in stomach, 47.8% in duodenum). Gram positive bacteria (G(+)) were colonized in 92.5% of E-samples, 73.7% of S-samples, and 69.6% of D-samples. The colonization rate of G(+) was significantly higher in esophagus than in stomach or duodenum. That was also significantly higher in patients with preoperatively proton pump inhibitor (PPI) medication than in patients without preoperatively PPI medication. Gram negative bacteria (G(-)) were colonized in 47.5% of esophagus, 44.7% of stomach and 43.5% of duodenum. The distribution of G(-) was no significantly related with the sample site or PPI medication. Anaerobe or fungus was not commonly colonized in upper gastrointestinal tract (anaerobe/fungus: 0%/10.0% in esophagus, 7.9%/13.2% in stomach, 4.3%/4.3% in duodenum).

Conclusion: We should pay special attention during operation to prevent spillage from esophagus in total gastrectomy or proximal gastrectomy cases or preoperative PPI medication given patients.