经自然腔道内镜腹腔探查术不同入路与技术差异的动物实验研究  

Natural orifice transluminal endoscopic surgery in non-survival porcine models： access and technique

作　　者：施宏[1] 蒋圣军[2] 王永光[1] 

机构地区：[1]同济大学微创医学研究所,北京100022 [2]北京微创医院

出　　处：《中华消化内镜杂志》2011年第3期150-153,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨经自然腔道内镜腹腔探查术中经胃、经结肠、经脐3种人路可行性，并对单纯经自然孔道内镜腹腔探查术和复合经自然孔道内镜腹腔探查术的利弊进行评价。方法选取2只家猪动物模型，分别行单纯经自然孔道内镜腹腔探查术与复合经自然孔道内镜腹腔探查术。每只猪均依次采用经胃、经结肠、经脐3种入路进行腹腔探查，记录每种人路的检查完成情况，术后尸解观察腹腔脏器损伤情况及造口闭合程度，对比单纯经自然孔道内镜腹腔探查术与复合经自然孔道内镜腹腔探查术的术中反应情况以及操作的难易程度。结果2只家猪术中生命体征均稳定，术后尸解均未见造口周围脏器损伤。经胃探查与经结肠探查均存在一定盲区，且闭合胃壁造口难于闭合结肠造口。经脐探查与腹腔镜技术相似。在安全造口、稳定气腹、充分探查方面，复合经自然孔道内镜腹腔探查术优于单纯经自然孔道内镜腹腔探查术。结论经自然孔道内镜腹腔探查术中经胃、经结肠、经脐3种人路在技术上均具有可行性，在使用现有内镜器械的条件下复合自然孔道内镜腹腔探查术优于单纯自然孔道内镜腹腔探查术。Objective To evaluate the feasibility, advantages and pitfalls of trans-gastric, trans-co- lonie and trans-umbilical peritoneoseopy, and to compare pure natural orifice transluminal endoscopic surgery （NOTES） with hybrid NOTES. Methods Two female pigs of 30kg were used in the study, one for pure NOTES, the other for hybrid NOTES. Each pig received trans-gastric, trans-eolonie and trans-umbilical per- itoneoscopy, respectively, followed by postmortem examination for organic lesions and closure of incisions. The two approaches were compared in terms of intra-operative situation and manipulation. Results The vital signs of the pigs were stable during the procedures, with no peri-ineision organic lesions. There were blind areas in trans-gastric as well as in trans-colonic peritoneoscopy. It was easier to close the colonic incision than the gastric one. The situation in trans-umbilieal peritoneoseopy was similar to laparoseopic surgery. Hy- brid NOTES seemed superior to pure NOTES with regard to safe access, stable pneumo-peritoneum and adequate visualization. Conclusion Three routes for NOTES appear to be reasonable and feasible. Hybrid NOTES is more effective and safer than pure NOTES with current instruments.

关 键 词：内窥镜 腹腔镜 单纯 复合 经胃 经结肠 经脐 

分 类 号：R657.4[医药卫生—外科学]