CAJ | 학술논문

目的探讨扩张探条辅助PEG法胃壁穿透术在自然腔道内镜外科(NOTES)中的应用价值.方法选择11只杂种犬,雌雄不限.首先对其中1只进行前期扩张探条辅助PEG法胃壁穿透术的可行性实验,在预实验成功后将剩余10只犬随机分成2组,分别进行传统PEG法胃壁穿透术(传统组)及胆道扩张探条辅助PEG法胃壁穿透术(改良组),比较2种方法在胃壁穿透效力方面的差别.完成实验的动物于术后第14天行常规胃镜检查,随后处死行腹腔探查,观察瘘口愈合、腹腔内粘连等情况.结果前期扩张探条辅助PEG法胃壁穿透术的可行性预实验获得成功.改良组均完成操作,而传统组4只完成操作,且前者平均胃壁穿透耗时(7.0±1.7)min明显少于后者(11.0±3.2)min(P＜0.05).2组完成操作的9只动物,术后2周均存活,无体质量下降及腹膜炎表现;术后第14天内镜下见瘘后愈合良好,探察示胃瘘口均已愈合好,未见腹腔脓肿,无近脏器(如肝、胆、脾等)损伤.结论扩张探条辅助PEG降低了NOTES穿壁过程的难度,能有效缩短操作耗时,且不会增加并发症,具有较好的应用价值.
목적 탐토확장탐조보조PEG법위벽천투술재자연강도내경외과(NOTES)중적응용개치.방법 선택11지잡충견,자웅불한.수선대기중1지진행전기확장탐조보조PEG법위벽천투술적가행성실험,재예실험성공후장잉여10지견수궤분성2조,분별진행전통PEG법위벽천투술(전통조)급담도확장탐조보조PEG법위벽천투술(개량조),비교2충방법재위벽천투효력방면적차별.완성실험적동물우술후제14천행상규위경검사,수후처사행복강탐사,관찰루구유합、복강내점련등정황.결과 전기확장탐조보조PEG법위벽천투술적가행성예실험획득성공.개량조균완성조작,이전통조4지완성조작,차전자평균위벽천투모시(7.0±1.7)min명현소우후자(11.0±3.2)min(P＜0.05).2조완성조작적9지동물,술후2주균존활,무체질량하강급복막염표현;술후제14천내경하견루후유합량호,탐찰시위루구균이유합호,미견복강농종,무근장기(여간、담、비등)손상.결론 확장탐조보조PEG강저료NOTES천벽과정적난도,능유효축단조작모시,차불회증가병발증,구유교호적응용개치.
Objective To explore the feasibility and safety of the biliary passage dilator assisted percutaneous endoscopic gastostomy(PEG)in natural orifice translumenal endoscopic surgery(NOTES).Methods Eleven hybrid dogs were recruited to the study.One dog was used for pilot study of biliary passage dilator assisted PEG.The rest ten were divied into 2 groups randomly(5 per group), receiving conventional PEG and biliary passage dilator assisted PEG, respectively.The efficacy and safety of these 2 methods in NOTES were compared.Two weeks later, routine gastroscopy was performed to detect the healing of luminal incision and all animals were sacrificed to explore the possible complications in the abdominal cavity.Results With the assistance of the biliary passage dilator, successful transgastric access to the peritoneal cavity was achieved in the pilot study.Biliary passage dilator assisted PEG was completed in all the 5 dogs of the experimetal group, while tradional PEG succeded in only 4.The average transgastric puncture time in the biliary passage dilator assisted PEG(7.0 ± 1.7 min)was significantly shorter than that of conventional PEG (11.0 ± 3.2 min, P ＜ 0.05).Nine dogs survived for 2 weeks postoperatively without loss of weight or peritonitis.Endoscopy showed transgastric puncture healed well.Autopsy revealed no gross adhering zone,bleeding, injury of adjacent organs or abcasses.Conclusion Compared with the conventional PEG, the biliary passage dilator assisted PEG shows the advantages of reduced difficulty and shoter time of puncture without any apparent complications.There is a good prospect of its application in NOTES.