透明帽吸引内镜夹闭合法在经自然腔道内镜外科手术切口闭合中的实验研究

Efficacy of endoscope clips with suction closure for the natural orifice transluminal endoscopic surgery access:a ex vivo porcine stomachs experiment

目的：探索经自然腔道内镜外科手术（NOTES）切口大小的选择以及闭合方法。方法以41例离体猪胃为模型，用针状刀直接切开做入路切口。按切口大小及闭合方法分为4组，A组8例做大切口（长度1．2～2．0cm），直接用内镜夹闭合；B组10例做大切口（长度1．2～2．0cm），用透明帽吸引下内镜夹闭合切口；C组10例做小切口（长度小于或等于1．1cm），直接用内镜夹闭合；D组13例做小切口（长度小于或等于1．1 cm ），用透明帽吸引下内镜夹闭合切口。闭合完成后行注水测漏试验，比较结果。结果 A组1例闭合良好，7例失败；B组2例闭合良好，8例失败；C组2例闭合良好，8例失败，D组11例闭合良好，2例失败。采用χ2 Fisher确切概率法检验分析各组数据。A组与B组、C组比较，差异无统计学意义（ P＞0．05）。A组与D组比较，B组与D组比较，差异有统计学意义（P＜0．05）。结论 NOTES切口以小于1 cm ，内镜刚好通过为佳，透明帽吸引内镜夹闭合法简单、实用、有效。

Objective To evaluate the feasibility and effectiveness of four closure techniques ,large incision with plastic distal at‐tachment and clip with suction ,1 .1 cm small incision with plastic distal attachment and clip with suction in natural orifice translu‐minal endoscopic surgery（NOTES） .Methods Forty‐one ex vivo porcine stomachs were involved in this research .According to the size of incision and different methods of incision closure ,all ex vivo porcine stomachs were divided into four groups .Group A in‐volved 8 ex vivo porcine stomachs ,their size of incision were 1 .2-2 .0 cm ,and their incisions were closured by a clip closure direct‐ly ;group B involved 10 ex vivo porcine stomachs ,their size of incision were 1 .2-2 .0 cm ,and their incisions were closed by plastic end attachment with suction and clip enclosure technique;group C involved 10 ex vivo porcine stomachs ,their size of incision were smaller than 1 .1 cm ,and their incisions were by a clip closure directly ;group D involved 13 ex vivo porcine stomachs ,their size of incision were smaller than 1 .1 cm ,and closured by plastic end attachment with suction and clip enclosure technique .Stomach leaks were evaluated by leaking studies after the procedure .Results In group A ,1 incision was closed successfully ,7 incisions were clo‐sured unsuccessfully ;in group B ,2 incisions were closed successfully ,8 incisions were closed unsuccessfully ;in group C ,2 incisions were closed successfully ,8 incisions were closured unsuccessfully ;in group D ,11 incisions were closed successfully ,2 incisions were Closured unsuccessfully .Fisher′s exact test showed that group D was significantly related to the success of incision closure .The were significant differences between group A and D ,group B and group D（P〈0 .05） .Conclusion Small incision（smaller than 1 cm） and plastic end attachment with suction and clip enclosure technique are optimal in NOTES procedure in this ex vivo porcine stomachs study .