经自然腔道内镜手术的实验研究

被引：14

作者：

王东 ^{[1
]}

郑永志 ^{[1
]}

吴仁培 ^{[1
]}

于恩达 ^{[2
]}

李兆申 ^{[1
]}

机构：

[1] 第二军医大学长海医院消化内科

[2] 第二军医大学长海医院普外科

来源：

中华消化内镜杂志 | 2009年 / 01期

关键词：

内窥镜外科手术; 猪; 经自然腔道内窥镜手术; 经胃路径; 经阴道路径;

D O I：

暂无

中图分类号：

R656 [腹部外科学];

学科分类号：

1002 ; 100210 ;

摘要：

目的初步探讨利用现有内镜器械经自然腔道内镜手术(NOTES)技术的可行性和安全性。方法采用6头雌性猪模型。经胃时首先用针刀在管壁穿透切开,ERCP拉式切开刀扩大切口,再用扩张气囊扩大通道,将胃镜送入腹腔。内镜在腹腔内寻找腹腔内器官,管壁切口用止血夹闭合,或自然旷置。NOTES术后1周经阴道切口进入腹腔观察;术后2周经胃壁其他部位切口重新进入腹腔观察,2例进行肝脏部分切除术;术后4周处死、解剖动物,观察腹腔内粘连、脏器损伤及管壁切口闭合情况。结果经胃壁进入腹腔12次,经阴道进入腹腔6次。经胃进入腹腔的平均时间为(33.4±10.9)min,经阴道平均时间为(10.1±2.5)min。用止血夹封闭胃壁切口或切口旷置,管壁切口均愈合良好,无明显并发症出现。再次腹腔探查时发现腹腔内有不同程度腹腔粘连,无腹腔脏器损伤。2例部分肝脏切除,1例出现膈肌损伤及死亡,1例成功。进入腹腔时出现切口出血2次,均为经胃切口时发生。出现腹腔脓肿1例。结论经胃、经阴道腹腔内镜探查及肝脏部分切除术是可行的,安全性较高,但NOTES专用器械的研发是NOTES顺利进行和成功的关键。

引用

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