腹腔镜联合经自然孔道内镜外科技术动物研究

目的 初步探讨腹腔镜联合经自然孔道内镜外科(NOTES)技术的操作方法、可行性及安全性.方法 采用雌性小型猪模型4头.先常规腹腔镜检查,腹腔镜监视下选择经胃壁切口的位置,经内镜用针状刀在胃前壁打孔,扩张球囊扩大切口后将内镜送入腹腔.腹腔镜和内镜配合下进行腹腔脏器探查、输卵管结扎、卵巢切除、胆囊切除及关闭胃壁切口,根据术中情况选择是否放置腹腔引流管.术后常规应用抗生素3 d,半流食饲养.2周后内镜检查胃壁切口腔内闭合情况,处死模型进行解剖,观察胃壁切口脏面闭合情况和手术部位改变.结果 两镜联合顺完成了腹腔脏器探查、输卯管结扎2次、卵巢切除2次、胆囊切除2次和胃壁切口闭合术.2头猪术后放置腹腔引流管.4头模型猪术后均存活至2周,体重增加;解剖后见胃壁切口愈合良好,脏面可见切口处少许组织粘连.手术部位无大出血及粘连,临近脏器无损伤,腹腔无脓肿.结论 腹腔镜联合经胃壁切口内镜下的腹腔脏器探查术、输卵管结扎术、卵巢切除术及胆囊切除术是可行的,具有一定的安全性.腹腔镜辅助可降低NOTES的难度.

Animal models of laparoscopy assisted natural orifice translumenal endoscopic surgery

Objective To explore the manipulation,feasibility and safety of laparoscopy assisted natural orifice translumenal endoscopic surgery(NOTES).Methods The technique was performed in 4 female porcine models.Diagnostic laparoscopy was performed first,and followed by transgastric access through the anterior gastric wall under the monitor of laparoscopy.The stoma was extended with the dilation ballon and the endoscope was sent to the abodominal cavity.Such procedures as endoscopic peritoneoseopy,fallopian tube ligation,oophorectomy,eholeeysteetomy and closure of gastrostomy were performed.The drainage tube and antibiotics of 3 days were used after operation according to the bleeding and potential risk of fistula and peritonitis.The animals were feeded on a semiliquid diet.Two weeks later,routine gastroseopy was pedbrmed to examine the healing of luminal incision.Subsequently,all models were sacrificed for the evaluation of the validity of NOTES.Results With the assistance of the laparoscope,endoscopic peritoneoseopy and,fallopian tube ligation,oophorectomy and cholecystectomy,twice for each,were successfully performed in all models.Abdominal drainage were used in two animals'after eholecystectomy.All porcines survived for 2 weeks postoperatively with no weight loss.Autopsic examination showed good healing of transgastric incisions,with little adhesion,no massive heinan'hage,abcesses,or injury to adjacent organs.Conclusion Combined laparoscopy and endoscopy for NOTES is feasible with relative safety.Laparoscopic assistance could facilitate the NOTES procedures at the present stage.