经胃途径内镜联合腹腔镜胆囊切除术的动物实验研究

目的初步探讨经胃途径内镜联合腹腔镜行胆囊切除术动物实验的安全性及可行性。方法从2010年7月至10月对6只五指山小型猪在全麻下行联合方式胆囊切除术，术中记录手术时间、并发症情况，术后观察实验动物饮食、体质量变化及术后2周对实验动物进行尸检观察造口愈合情况及腹腔内有无感染、脓肿及粘连等并发症发生。结果6只动物均成功行胆囊切除，除1只动物因术中出血行腹腔镜止血外，无其他并发症发生。平均手术时间为87min（69—124min）。所有动物均存活2周，2周后实验动物进食量及体质量无明显变化，尸检时没有发现的脓肿、出血等并发症，造口愈合良好。结论联合腹腔镜的方式保证了经自然腔道途径外科手术的安全性和可行性，同时降低了单纯腹腔镜手术的创伤，是一种向单纯经自然腔道行外科治疗较为可靠的过渡方式。

Hybrid trans-gastric endoscopic and laparoscopic cholecystectomy in a porcine model

Objective To assess the safety and feasibility of hybrid trans-gastric endoscopic and laparoscopic cholecystectomy in a porcine model.Methods A total of 6 pigs underwent hybrid trans-gastric endoscopic and laparoscopic cholecystectomy from July to October,2010 under general anesthesia.The operation time and complications during the procedure were recorded,as well as post-operative changes of eating habits and weight.Animals underwent autopsies on post-operative days(POD)14 for evaluation of infection,abscesses and adhesion.Results All procedures were successfully performed and all dogs survived.There was no severe complication except for hemorrhage in one porcine,which was successfully managed under laparoscopy.The mean operation time was 87mins(ranging from 69-124 mins).After the operation,there was no change in eating habits or weight.At autopsy on POD 14,no abscess or hemorrhage was found.Sites of gastric closure were found to be completely healed.Conclusion The hybrid approach increases the safety of initial gastric puncture and gastric wall incision,simplifies peroral trans-gastric cholecystectomy,and decreases invasiveness of laparoscopic surgery.It is a bridge between laparoscopic and transluminal surgery.