内镜下经口经食管隧道技术进行纵隔活检动物实验的可行性研究  

Endoscopic transesophageal biopsy of living tissue in the posterior mediastinum using submucosal tunneling technology:study of feasibility and safety in a survival series

作　　者：令狐恩强[1] 秦治初[1] 翟亚奇[1] 李惠凯[1] 张永潮[1] 

机构地区：[1]中国人民解放军总医院消化科,北京100853

出　　处：《中华腔镜外科杂志（电子版）》2012年第5期12-14,共3页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的 研究利用隧道技术在活体家猪体内进行纵隔活检的安全性及可行性。方法 健康家猪3只,麻醉后取左侧卧位,在食管中段横行切开长约2cm黏膜,内镜沿切口进入黏膜下建立约10cm隧道,切开食管壁肌层进入纵隔,术中辨别纵隔器官(如肺、脊椎、降主动脉等),进行纵隔组织活检,食管固有肌层不关闭,金属夹自远端向近端闭合切口。术后送活组织病理及胸透,糖水饮食72h,之后流质饮食,应用抗生素3d,每日检测体温,1周后复查胃镜。结果 所有实验用猪均完成操作,纵隔内器官均能被清楚辨认,进行了纵隔内活组织检查,其中1例因无法解释的气胸术后死亡,尸检见到明显的肺不张;另外1例发生轻微的气胸,食管切口均用金属夹关闭。结论 内镜下经口经食管隧道技术进行纵隔活检是可行的,而该手术的安全性则需要我们扩大样本量及延长生存时间去进一步研究并发症。Objective This animal study was performed to explore the feasibility and safety of endoscopic transesophageal biopsy of living tissue using a novel tunneling technology in the posterior mediastinum.Methods The procedure was performed on three healthy domestic pigs on left sides under general anesthesia.An 6 mm video endoscope was introduced into the esophagus,a mid-esophageal mucosal incision was performed using an endoscope,and a 10 cm submucosal tunnel was developed with blunt dissection.The mediastinal compartment,lung,the descending thoracic aorta, and exterior surface of the esophagus were identified.Mediastinal living tissue biopsy was easily accomplished.the muscular layers of esophagus was not closed,and the mucosal incision was closed using titanium clips.After the procedure,pathological examination of living tissue,blood test and chest radiograph were performed, sugar water for first 72 h were fed and antibiotics were used,and then in the following days liquid food were fed.During 1 survival weeks,temperature monitoring were performed.Another gastroscopy was repeated one week after the procedure.Results The procedure was performed successfully in all three pigs. Mediastinal structures could be identified without difficulty by the transesophageal tunneling approach,living tissue biopsy under direct visualization was feasible.One pig died after operation due to an unexplained pneumothorax.At necropsy, apparent atelectasis was noted in right lobe. After appling homemade drainage tube attached to the syringe. The other pig with pneumothorax soon had restoration.The mucosal incision site healed completely in all pigs,the last pigs had an uneventful recovery and showed no apparent ill effects.Conclusions Endoscopic transesophageal removal of living tissue in the posterior mediastinum using a novel tunneling technology are feasible.These procedures would be performed safely in swine with short-term survival if further study with a larger sample size and longer survival is warranted for complications.

关 键 词：隧道技术 纵隔 

分 类 号：R655.5[医药卫生—外科学]