[1]王子恺,孙刚,肖建国,等.经自然腔道内镜手术实验研究*[J].中国微创外科杂志,2009,09(12):1074-1078.
　Wang Zikai,Sun Gang,Xiao Jianguo,et al.Natural Orifice Translumenal Endoscopic Surgery (NOTES) in Animals[J].Chinese Journal of Minimally Invasive Surgery,2009,09(12):1074-1078.
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经自然腔道内镜手术实验研究*()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
09
期数:
2009年12期
页码:
1074-1078
栏目:
实验研究
出版日期:
2009-12-31

文章信息/Info

Title:
Natural Orifice Translumenal Endoscopic Surgery (NOTES) in Animals
作者:
王子恺; 孙刚; 肖建国; 王向东; 唐平; 黄学飞; 吴丽丽; 袁作辉; 刘哲①; 王敬①; 李闻**
解放军总医院消化科，北京100853
Author(s):
Wang Zikai;  Sun Gang;  Xiao Jianguo;  et al.
Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
关键词:
经自然腔道内镜手术; 腹腔镜; 动物实验; 并发症
Keywords:
NOTES; Laparoscopy; Animal experiment; Complication
分类号:
R-332
文献标志码:
A
摘要:
目的探讨NOTES完成动物腹部多种手术成功与失败的原因，为其应用于临床提供实验依据。方法回顾分析2007年8月~2009年9月完成的全部动物实验数据。研究分为急性实验和存活实验2部分，采用雌性小型猪和成年杂种犬，分别开展了单纯NOTES和腹腔镜辅助的NOTES。进行诊断性腹腔探查和肝脏活检术，治疗性胆囊切除、输卵管结扎切除、卵巢切除、脾切除和胃空肠吻合等腹部手术。记录术中和术后并发症的发生情况，以及操作过程中遇到的技术难题。结果采用37只小型猪和16只杂种犬，完成急性实验22例，存活实验31例。共开展各种NOTES手术91例次，其中单一经胃路径25例次，单一经结肠路径8例次，经胃和结肠联合路径16例次，经胃和阴道联合路径6例次，传统腹腔镜辅助经胃路径26例次，单孔腹腔镜辅助经胃路径10例次。完成诊断性腹腔探查术33例，成功率100% (33/33)，肝脏活检术11例，成功率100% (11/11)，输卵管结扎切除术11例，成功率100%(11/11)，卵巢切除术6例，成功率100% (6/6)，胆囊切除术27例，成功率44.4% (12/27)。另行脾切除术1例和胃空肠吻合术2例，均未成功。总的并发症发生率为39.6%(21/53)，其中穿孔8例，脏器损伤5例，出血4例，腹腔感染3例，腹压过高导致动物死亡1例。结论NOTES用于诊断性腹腔探查和简单治疗是安全有效的，但完成腹部较复杂的手术尚不可行。腹腔镜辅助NOTES的方法或许是此项技术从动物实验过渡到临床应用的桥梁。
Abstract:
ObjectiveTo investigate the causes of success or failure of natural orifice translumenal endoscopic surgery (NOTES) in animals.MethodsData were collected from animal studies of NOTES carried out between August 2007 and September 2009. The studies were divided into acute phase and survival phase. In the studies, simple NOTES and laparoscopicassisted NOTES were performed on female miniswines or adult mongrel dogs. Diagnostic abdominal exploration, liver biopsy, cholecystectomy, tubal ligation, oophorectomy, gastrojejunal anastomosis, and splenectomy were made in the animals. The intra and postoperative complications and technical difficulties were recorded during the procedures. ResultsTotally 37 miniswines and 16 mongrel dogs were enrolled in the studies of NOTES procedures (91 procedures), including 22 acute experiments and 31 survival experiments. Simple NOTES was conducted through the transgastric route in 25 cases, transcolonic route in 8 cases, and combinations of transgastric and transcolonic routes in 16 cases, and combinations of transgastric and transvaginal routes in 6. In Laparoscopicassisted cases, 36 animals were treated via the transgastric route by traditional (26 cases) or singleport transumbilical laparoscopy (10 cases). Diagnostic exploration was carried out in 33 cases, liver biopsy was done in 11 cases, tubal ligation was made in 11, and oophorectomy was performed on 6; the procedures were all completed in these cases showing a success rate of 100%. Cholecystectomy was completed in 27 cases with a success rate of 44.4% (12/27). One case of splenectomy, and two cases of gastrojejunal anastomosis failed. The totally complication rate in the studies were 39.6%(21/53). The complications included perforation (8 cases), organ injury (5 cases), bleeding (4 cases), infection (3 cases) and pneumoperitoneum with hypertonia (1 case).ConclusionsNOTES is feasible, safe and effective in diagnostic abdominal exploration and simple abdominal surgeries, but does not suit difficult abdominal surgeries. By using laparoscopy, the technique may be further developed and used in the future.

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备注/Memo

备注/Memo:
*解放军总医院技术创新项目(07CX202)**通讯作者①肝胆外科
更新日期/Last Update: 2014-01-08