经自然腔道内镜经皮穿刺置管回肠造瘘术的活体实验研究

Research on in Vivo Experiment of Natural Orifice Transluminal Endoscopic Percutaneous Puncture Catheterization Ileostomy

目的评价经自然腔道内镜手术(NOTES)经皮穿刺置管回肠造瘘术猪动物模型的应用价值。方法该实验于2014年5月—2015年8月在南京军区福州总医院动物实验中心进行。选择6只雌性家猪为模型,分为:A组(3只):术后处死组和B组(3只):1周后处死组。家猪经口置入胃镜,胃镜经胃粘膜下移行后进入腹腔,定位回肠末段据回盲瓣10~20 cm为造瘘口。在内镜直视下把造瘘段回肠提向腹壁,从体外应用双腔环固定装置,将造瘘段回肠缝合固定于腹壁上。将戳卡穿刺入腹腔和固定的回肠,通过戳卡孔插入水囊式胃造瘘管。采用圈套器关闭胃粘膜切口。结果在6只猪中均顺利行NOTES经皮穿刺置管回肠造瘘术,平均手术时间为(71.9±13.8)min,两组动物均无大出血或严重并发症情况。结论 NOTES经皮穿刺置管回肠造瘘术在技术上是可行的,可重复的,值得进一步改进。

Objective To evaluate the application value of natural orifice transluminal endoscopic percutaneous puncture catheterization ileostomy for hog models.Methods The experiment was conducted in the Animal Experimental Center of Fuzhou General Hospital of Nanjing Military Area from May 2014 to August 2015,6 female hogs were selected as the models,including 3 cases in the group A,(postoperative death group)and 3 cases in the group B,death group after 1 week,the gastroscope was placed through mouths,then into abdominal cavity after the gastric mucosa was down,the anastamosis was oriented at 10 cm to 20 cm from terminal ileum to ileocecal valves,and the fistula ileum was lifted to the abdominal wall?under esophagoscope,and the gastric mucosa incision was closed by the snare.Results 6 hogs successfully finished the natural orifice transluminal endoscopic percutaneous puncture catheterization ileostomy,and the average operation time was(71.9±13.8)min,and there were no hemorrhea or severe complications in the two groups.Conclusion The natural orifice transluminal endoscopic percutaneous puncture?catheterization ileostomy is feasible technologically and repeatable,which is worth further improvement.