网膜填塞法闭合经自然腔道内镜手术胃壁瘘口的研究

目的应用动物模型评价网膜填塞法闭合经自然腔道内镜手术(NOTES)胃壁瘘口方法的可行性及有效性。方法 29只杂种犬经胃前壁内镜下全层切开(10 mm),经此入路完成NOTES腹腔探查术,其中12只应用网膜填塞法闭合胃壁瘘口(网膜填塞组),17只内镜钛夹闭合(钛夹组),闭合成功动物术后存活2周。比较两种胃壁瘘口闭合术的操作耗时、闭合成功率以及瘘口愈合和腹腔感染发生率。结果网膜填塞法闭合胃壁瘘口的成功率为91.7%(11/12),高于内镜下钛夹闭合方法成功率82.4%(14/17),但未见显著统计学差异(P>0.05);网膜填塞闭合法操作平均耗时(11.7±2.1)min/例次,明显低于钛夹闭合法(25.0±5.6)min/例次(P<0.05)。25只动物胃壁闭合成功后者术后均存活14 d,复查胃镜见胃壁瘘口愈合良好。处死后实验动物未发现腹腔严重感染及明显脏器损伤;网膜填塞组8只犬(72.7%,8/11)可见胃壁瘘口处胃壁浆膜面黏连,显著高于钛夹闭合组(14.3%,2/14,P<0.05)。结论网膜填塞法能有效闭合NOTES经胃壁瘘口,与传统内镜钛夹闭合法相比具有操作简单、成功率高的优点,但容易发生瘘口黏连是其明显不足。

Omentoplasty for gastrotomy closure after natural orifice transluminal endoscopic surgery

Objective To investigate the feasibility and efficacy of omentoplasty for gastrotomy closure after natural orifice transluminal endoscopic surgery(NOTES).Methods Among the 29 domestic dogs with gastric anterior wall puncture(10 mm) for intraperitoneal exploration,twelve dogs underwent omentoplasty for gastrotomy closure(omentoplasty group),while seventeen dogs underwent standard endoclips for gastrotomy closure(endoclip group),and the experimental animals with successful closure of gastrotomy were followed 2 weeks post the operation.The time consumption,success rate,healing status of the closure,and complications after the procedure were analyzed and compared between both groups.Results Although there was no statistical significance(P>0.05),the success rate of gastrotomy closure in the omentoplasty group was also higher than that in the endoclip group(91.7% vs 82.4%).The average time consumption for gastrotomy closure was 11.7 min±2.1 min in omentoplasty group,significantly shorter than that in the endoclip group(25.0 min±5.6 min,P<0.05).Gastroscopy revealed good healing of all the gastrotomies in the 25 survival dogs at the end of 2 weeks after the operation.No signs of intraperitoneal inflammation and adjacent organ injuries were found during necropsy,however,serosal adhesion of the gastrotomy was found in 8 dogs(72.7%,8/11)in the omentoplasty group,significantly higher than that in the endoclip group(14.3%,2/14,P<0.05).Conclusion Omentoplasty is a feasible and effective approach for gastrotomy closure in NOTES procedure,with the advantages of simple manoeuvrability and higher success rate for sealing gastrotomy compared with the standard endoclip.High incidence of adhesion is the apparent pitfall of omentoplasty for gastrotomy closure.