软式内窥镜在腹部创伤中诊治作用的实验研究

Role of flexible endoscopy in the diagnosis and treatment of abdominal trauma:An animal experimental study

目的通过对腹部刀刺伤动物模型治疗的对照研究,探索软式内窥镜对腹部创伤的诊治作用。方法16只比格犬随机分为内镜组(n=8)和开腹组(n=8);在软式内镜的视野下,用统一大小匕首刺中实验犬肝、脾、肠管、肠系膜血管制作动物创伤模型。造模成功30 min后对实验犬行救治,内镜组采用软式内窥镜经腹壁皮肤创口直接进入腹腔进行诊断和治疗,开腹组取腹部正中切口开腹进行诊治。比较2组实验犬的呼吸频率、心率、血压、血氧饱和度、创伤及手术情况、总手术时间、腹腔探查时间、病灶治疗时间,术后观察实验犬进食及饮水量、恢复正常进食量的时间、对外界刺激反应及体重变化情况。2周后处死并解剖,评估2组术中有无漏诊,观察并比较2组腹腔内有无感染灶、黏连等术后并发症。结果内镜组仅通过体表创口进入腹腔治疗,其中有1只实验犬因视野受到出血的影响,无法诊断出血部位外,中转开腹,余均成功完成内窥镜下诊断和治疗,且2周后解剖诊断均证实术中诊断无误。2组在呼吸频率、心率、血压、血氧饱和度、手术成功率及术后存活率方面上差异均无统计学意义(P>0.05)。内镜组与开腹组的总手术时间分别为(35.67±6.67)min与(19.72±1.55)min(Z=-3.240,P=0.001),腹腔探查时间分别为(15.50±3.28)min与(4.33±1.00)min(Z=-3.240,P=0.001),病灶治疗时间分别为(10.13±5.15)min与(5.43±0.52)min(Z=-2.606,P=0.009)。除开腹组1只实验犬死亡外,其余存活的实验犬饮食、活动度、对外界刺激反应良好,体重无明显下降,内镜组24 h内恢复正常进食量比例85.71%(6/7)优于开腹组25.00%(2/8)(P=0.041),腹腔黏连发生率14.29%明显少于开腹组100%(P=0.001)。结论软式内窥镜治疗腹部创伤具有一定的诊治能力,具有二次创伤小、恢复快、并发症少等优点。临床上还需进一步评估其安全性及有效性。

Objective To explore the role of flexible endoscopy in the diagnosis and treatment of abdominal trauma by comparing the treatment of abdominal knife stabbed the animal model.Methods Sixteen beagles were randomly divided into the endoscopy group(n=8)and open group(n=8).Animal trauma models were made by stabbing the liver,spleen,intestinal canal and mesenteric vessels of animals with a dagger of the same size under the visual field of flexible endoscopy.Thirty minutes later,the experimental animals were treated.In the endoscopy group,flexible endoscopy was used to enter the abdomen through the abdominal wall wound for treatment.In the open group,open surgery was used to treat abdominal trauma.Respiratory frequency,heart rate,blood pressure,oxygen saturation,trauma and operation size,total operation time,abdominal exploration time and treatment time were compared between the two groups.After the operation,the amount of food and water consumed,the time of restoring normal food intake,the response to external stimuli and the change of weight was observed.Two weeks later,the animals were sacrificed and dissected to determine whether there was any missed diagnosis before the operation.Complications of abdominal infection and adhesion were observed and compared between the two groups.Results In the endoscopy group,all the experimental animals were treated by endoscopy through abdominal wounds into the abdomen,One of the experimental animals was unable to diagnose the bleeding site because of the influence of bleeding on the visual field.Other animals were successfully diagnosed and treated under endoscopy.Two weeks later,the intraoperative diagnosis was confirmed by animal anatomy.There were no significant differences in respiratory rate,heart rate,blood pressure,oxygen saturation,the success rate of the operation,infection rate and survival rate between the two groups.(all P>0.05).The total operation time was(35.67±6.67)min and(19.72±1.55)min(Z=-3.240,P=0.001),the time of abdominal exploration was(15.50±3.28)min and(4.33±1.00)min(Z=-3.240,P=0.001),and the treatment time was(10.13±5.15)min and(5.43±0.52)min(Z=-2.606,P=0.009)in the endoscopy group and the open group,respectively.In addition to the death of one animal in the open group,the diet,activity,and response to external stimuli of the remaining surviving experimental animals were normal,and their weight did not decrease significantly.Within 24 hours,85.71%(6/7)of the endoscopy group and 25.00%(2/8)of the open group returned to normal intake,respectively(P=0.041).The incidence of abdominal adhesion in the endoscopy group and the open group was 14.29%and 100%,respectively(P=0.001).Conclusion Flexible endoscopy has the ability to treat abdominal trauma.At least it has the advantages of Less surgical trauma,rapid recovery,and fewer complications.It necessary to further evaluates its clinical safety and efficacy.