经自然腔道内镜手术的实验研究

目的初步探讨利用现有内镜器械经自然腔道内镜手术（NOTES）技术的可行性和安全性。方法采用6头雌性猪模型。经胃时首先用针刀在管壁穿透切开，ERCP拉式切开刀扩大切口，再用扩张气囊扩大通道，将胃镜送入腹腔。内镜在腹腔内寻找腹腔内器官，管壁切口用止血夹闭合，或自然旷置。NOTES术后1周经阴道切口进入腹腔观察；术后2周经胃壁其他部位切口重新进入腹腔观察，2例进行肝脏部分切除术；术后4周处死、解剖动物，观察腹腔内粘连、脏器损伤及管壁切口闭合情况。结果经胃壁进入腹腔12次，经阴道进入腹腔6次。经胃进入腹腔的平均时间为（33．4±10．9）min，经阴道平均时间为（10．1±2．5）min。用止血夹封闭胃壁切口或切口旷置，管壁切口均愈合良好，无明显并发症出现。再次腹腔探查时发现腹腔内有不同程度腹腔粘连，无腹腔脏器损伤。2例部分肝脏切除，1例出现膈肌损伤及死亡，1例成功。进入腹腔时出现切口出血2次，均为经胃切口时发生。出现腹腔脓肿1例。结论经胃、经阴道腹腔内镜探查及肝脏部分切除术是可行的，安全性较高，但NOTES专用器械的研发是NOTES顺利进行和成功的关键。

Natural orifice transluminal endoscopic surgery on animal models

Objective To evaluate the safety and feasibility of natural orifice transluminal endoscopic surgery(NOTES)with current available techniques and endoscopic accessories.Methods Transgastric and transvaginal endoscopic abdominal cavity exploration were performed in 6 female pigs.A needle-knife and a ERCP scalpel were used to make an anterior gastric wall incision,and a dilating balloon to expand the passage,through which a therapeutic gastroscope was sent into the abdominal cavity to seek the target organ.Partial liver resection was performed in 2 cases.For incision closure,a clip was applied to the incision orifice or it was just given putting-aside therapy.One week later,the abdominal cavity was examined via vagina.Another week later,it was observed via other incision of the stomach.Four weeks after the operation,the pigs were sacrificed.Adhesion,injury to the organs and closure of the incision were evaluated.Results Transgastric procedures were performed 12 times and transvaginal procedures 6 times.Mean operation time via stomach was 33.4±10.9 min.and that via vagina WaS 10.1±2.5 min.All animals recovered and gained weight after the operation.The incision healed up with no obvious complications.Re-exploration showed adhesion of various degrees,no effusion,or injury to the organs were observed.Ketamine plus propofol achieved satisfactory anesthetic effect with no complications.One of the two animals which underwent liver partial resection died of disphragmatic muscle perforation.Hemarrhage occurred twice,both in the procedures via satisfied.One case developed abdominal abscess.Conclusion It Was feasible and safe to perform NOTES via transgastric and transvaginal approach to the abdominal cavity and liver resection.But development of NOTES specific instruments is essential to the procedure.