经胃、结肠与经胃、阴道双路径猪输卵管切除术和肝脏活检术的比较研究

Trans-gastric combined with trans-colonic or trans-vaginal route endoscopic salpingectomy and liver biopsy in a live porcine model

目的探讨经胃、经结肠路径联合与经胃、经阴道路径联合的内镜外科学技术（NOTES）切除猪输卵管和肝脏活检的可行性和安全性。方法将雌性中国农大小型猪4头分为两组，A组2头经胃、经结肠路径联合腹腔内镜探查术及输卵管切除术；B组2头经胃、经阴道联合腹腔内镜探查术及输卵管切除术。术后处死动物并解剖，观察每组发生并发症情况。结果两种联合途径对腹腔内NOTES操作难易程度相仿，均可完成腹腔探查术、输卵管切除术及肝脏活检术。但是当内镜穿过结肠壁进入腹腔时，发生邻近结肠穿孔1例。结论经胃、经结肠路径联合与经胃、经阴道路径联合NOTES猪输卵管切除术和肝脏活检术是可行的，但经阴道路径似乎比经结肠路径更安全。

Objective To investigate the feasibility and safety of trans-gastric route combined with trans-colonic or trans-vaginal route endoscopic salpingectomy and liver biopsy, as methods of natural orifice translumenal endoscopic surgery （NOTES）. Methods Endoscopic salpingectomy and liver biopsy were performed in 4 female porcine models, in 2 of which the procedure was achieved via trans-gastric and trans-colonic route （ Group A）, while in other 2 was via trans-gastric and trans-vaginal route （Group B）. The animals were sacrificed after the procedure and the related complications were observed. Results Abdominal cavity exploration, salpingectomy and liver biopsy could be performed successfully through two combined routes. Perforation of adjacent colon was found in 1 animal with the trans-colonic route NOTES. Conclusion NOTES via trans-gastric and trans-colonic routes or via trans-gastric and trans-vaginal for salpingectomy and liver biopsy are both feasible, while trans-vaginal route seems to be safer than trans-colonic route.