Objective To investigate the impact of vaginal microbiota on transvaginal pelvic surgery.Methods Forty-five patients undergoing transvaginal pelvic surgery from December 2013 to December 2014 were enrolled.Immediately after hospitalization,vaginal discharge samples from patients were cultured.Three days prior to the operation,0.5％ iodophor product was used for vaginal scrubbing,and prophylactic antibiotics were administered 30 minutes prior to the routine surgery.Surgeries on uterus,ovary,and oviduct were performed via the anterior or posterior vaginal fornix to reach the abdominal cavity.The vaginal incision was closed after the surgery.The patients with positive opportunistic pathogens were set as an observation group (15 cases),the patients with negative opportunistic pathogens or positive lactobacilli were set as a control group (30 cases).The clinical data and perioperative indices were compared between the two groups.Results The positivity rate of the vaginal discharge cultures was 68.9％ (31/45),including33.3％ (15/45) of opportunistic pathogens and 35.6％ (16/45) of lactobacilli.There were 18 strains of opportunistic pathogens (except for lactobacilli).The results of a drug susceptibility test showed that the susceptibility and resistance rates of opportunistic pathogens to prophylactic antibiotics were 55.6％ (10/18) and 38.9％ (7/18),respectively.Antifungal agents were not applied in 1 case.No statistical difference was observed between the observation and control groups in terms of patients' general information and surgical type (P ＞ 0.05).The recovery time for the bowel was shorter in control group than that in observation group [1.0 (1.0,2.0) d vs 2.0 (1.0,2.0) d] (P ＜ 0.05).No statistical difference was observed in perioperative indices between the two groups (P ＞ 0.05).Conclusions Prior to transvaginal pelvic surgery,negative results of vaginal discharge smear and regular vaginal scrubbing can ensure a safe surgery.Vaginal microbial has no significant effects on transvaginal pelvic surgery.%目的 探讨阴道微生物对经阴道盆腔手术的影响.方法 选取2013年12月至2014年12月于北京积水潭医院行经阴道盆腔手术的患者45例,住院后立即行阴道分泌物培养.术前3d用0.5％碘伏消毒液进行阴道擦洗,术前30 min常规预防性应用抗菌药物.手术经阴道前或后穹窿入腹腔,行子宫、卵巢和输卵管手术,术后关闭阴道切口.将培养出条件致病菌的患者分入观察组(15例),未培养出条件致病菌或单纯培养出乳酸杆菌的患者分入对照组(30例).比较2组患者一般资料和围术期手术指标.结果 阴道分泌物培养阳性率为68.9％(31/45),其中培养出乳酸杆菌患者16例(35.6％),培养出其他条件致病菌患者15例(33.3％).条件致病菌(除外乳酸杆菌)合计18株.药物敏感试验结果显示,针对条件致病菌预防性应用抗菌药物敏感率为55.6％ (10/18),耐药率为38.9％ (7/18),1例患者术前未用抗真菌药物.2组患者一般资料和手术类型之间比较差异均无统计学意义(均P＞0.05).对照组肛门排气时间短于观察组[1.0(1.0,2.0)d比2.0(1.0,2.0)d],差异有统计学意义(P＜0.05),2组其余围术期指标比较差异无统计学意义(P＞0.05).结论 经阴道盆腔手术前,只需要阴道分泌物涂片阴性和常规阴道擦洗就可以安全手术.阴道微生物对经阴道盆腔手术无明显影响.
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