经自然腔道内镜手术临床研究进展

Natural orifice transluminal endoscopic surgery: The progress of clinical research

自经自然腔道内镜手术(natural orifice transluminal endoscopic surgery,NOTES)第1次提出以来,大量的临床NOTES报道已经出现。文中综述了白皮书最初所提到的多种研究问题的临床数据,包括腹腔入路、入路切口关闭、缝合吻合设备、腹腔内并发症及出血、不可预期的生理变化、预防感染、内部空间定位的导航与维持、多功能操作平台的发展和培训等。结果显示目前经阴道的入路与切口关闭技术最为纯熟;理论上行NOTES可增加感染的发生率未被证实;而缝合吻合设备和多功能操作平台的发展由于诸多原因发展较为缓慢;并发症的发生率较小;优化管理培训仍需进一步完善。

Since the first description of the concept of natural orifice transluminal endoscopic surgery（NOTES）, a number of clinical NOTES reports have been published. This article reviews clinical research questions proposed by the white paper, including access to the peritoneal cavity, visceral closure, development of suturing or anastomotic devices, intraperitoneal complications, bleeding, unpredictable physiological changes, risk of infection, spatial orientation, development of a multitasking platform, training. The outcomes reveal that so far transvaginal access and closure is most feasible technique. The theoretically increased risk of infection has been unsubstantiated as result of NOTES. Due to a variety of reasons, development of suturing or anastomotic devices and multitasking platform has progressed slowly. The incidence of complications remain spare. Optimal management and training need to be further improved.