经胃、结肠联合路径腹腔内镜探查术的实验研究

Combination of transgastric and transcolonic routes for natural orifice translumenal endoscopic surgery(NOTES)

目的初步探讨经胃(口)和经结肠(肛)双路径经自然孔道内镜外科学(NOTES)技术的可行性和利弊。方法采用雌性猪模型。先经口路径用针刀在胃前壁穿透切开,用扩张球囊扩大通道,将胃镜送入腹腔,在经胃路径的内镜监视下,再经肛路径用针刀穿透结肠壁,用弓刀扩大肠壁切口,将内镜送入腹腔。两条内镜先分别单独寻找胆囊和输卵管,然后相互配合共同寻找和观察胆囊和输卯管。胃肠切口分别用止血夹闭合。术后立即剖腹探查,观察腹腔内脏器损伤及胃肠壁切口闭合情况。结果胃肠壁通过球囊和弓刀扩大切口均无出血。经胃壁穿透切开时损伤肝脏表面。在经胃路径的内镜监视下完成结肠壁切开,避免了临近脏器的损伤。单内镜寻找胆囊和输卵管困难,时间较长。而双内镜配合寻找胆囊和输卵管相对容易,时间缩短,视野暴露好。用止血夹封闭胃壁切口比结肠切口困难。结论经胃与经结肠联合路径腹腔内镜探查术是可行的,可能比单路径更容易完成NOTES 操作。

Objective To explore the feasibility, advantages and disadvantages of combined transgastric and transcolonic routes for NOTES. Methods A female swine was used in this study. Transgastric entrance was the first, followed by transcolonic entrance. A dual-channel endoscope was inserted through the porcine mouth into the gastric cavity and penetrated into the peritoneal cavity through the puncture and balloon dilatation of the gastric wall. Then under direct visualization through the transgastric approach, the other endoscopewas advanced into the peritoneum. Using the two endoscopes inside the peritoneal cavity, collabo-rative peritoneoscopy was performed by the two endoscopists. After the examination the incisions in the stomach and the colon wall were dosed with Endoclips. The animal was sacrificed for post-mortem examination with particular attention to the entrance sites and presence of any complications related to the access or to manipulations inside the peritoneal cavity. Results No hemorrhage occurred during the puncture and balloon dilatation or bow-knife cutting of the gastric wall or the colonic wall. The liver was damaged while a needle knife penetrated the gastric wall. On the contrary, no organs were damaged during the needle knife penetrated the colonic wall under direct visualization through the transgastric approach. It was difficult to find the gallbladder or the oviduct with a ＂single ann＂, but it was easy to see them with the double routes. It was easier to close the colonic incision than to close the gastric wall with Endoclips. Conclusion Combined transgastric and transcolonic route for NOTES is feasible and it seems to be easier to show a target compared with a single route.