经胃自然腔道内镜手术行胆囊探查术的可行性及安全性研究

目的探讨经胃自然腔道内镜手术(NOTES)在小型猪体内行胆囊探查术的最佳进镜部位及其安全性和可行性。方法以13只小型猪为动物模型,将6只实验动物分为3组,每组2只,分别以胃窦前壁大弯侧、胃窦前壁小弯侧、胃体窦交界处小弯侧为胃壁入口行腹腔探查,并选取探查胆囊的最佳进镜部位,完成胆囊活检以及胆囊息肉切除等操作,另外7只实验动物根据腹腔探查范围及探查胆囊难易程度确定最佳入口。记录手术时间,计算胆囊探查成功率、实验动物并发症发生率以及病死率,术后3个月解剖实验动物观察腹腔情况。结果实验动物存活率为84.62%,胃窦前壁小弯侧是探查胆囊的最佳进镜部位,以此为入口进行胆囊探查术的成功率为77.78%,平均手术时间为(75.0±17.68)min,术中完成了胆囊息肉切除术及胆囊活检术。实验动物无并发症发生,解剖可见腹腔内无严重粘连,胆囊愈合良好。结论经胃NOTES中胃窦前壁小弯侧可视为探查胆囊的最佳进镜部位,由此部位进行胆囊息肉切除术、胆囊黏膜活检术等操作均安全可行。

Feasibility and safety of gallbladder exploration by trans-gastric natural orifice transluminal endoscopic surgery

Objective To analyze the best entry site of stomach in trans-gastric natural orifice transluminal endoscopic surgery(TG-NOTES)for gallbladder exploration and its safety and feasibility in a survival porcine model.Methods Thirteen mini-pigs were selected for TG-NOTES.Six of the pigs were divided into three groups,with 2 cases in each group.Entered the abdominal cavity through the greater curved side of the anterior wall of the gastric antrum,the lesser curved side of the anterior wall of the gastric antrum,and the lesser curved side of the junction of the gastric body and antrum respectively and completed abdominal exploration.During the abdominal exploration,the best entry site was determined to explore the gallbladder and complete the gallbladder biopsy and gallbladder polypectomy.The remaining pigs′best entry sites were determined according to the scope of abdominal exploration and the difficulty of gallbladder exploration.The operation time,the success rate of gallbladder exploration,intraoperative and postoperative complications and mortality of experimental animals were recorded and calculated.Dissected the pigs to observe the intraperitoneal condition three months after operation.Results The experimental animals′survival rate was 84.62%.The lesser curved side of the anterior wall of the gastric antrum was the best entry site for gallbladder exploration.The success rate of gallbladder exploration with this entry site was 77.78%,and the average operation time was(75.0±17.68)minutes.In addition,gallbladder polypectomy and gallbladder biopsy were completed intraoperatively.There was no postoperative complications occured.Anatomy showed that there was no severe adhesion in the abdominal cavity and the gallbladder healed well.Conclusion The lesser curved side of the anterior wall of the gastric antrum was the best entry site for gallbladder exploration.The feasibility and safety of gallbladder polypectomy and mucosal biopsy through TG-NOTES has been preliminary verified.