CAJ | 학술논문

目的对比研究自然腔道内镜外科(NOTES)中PEG胃造瘘术及针刀胃造瘘术在操作过程、并发症及瘘口愈合方面的差异.方法实验犬随机分为4组,每组4只,每只犬胃前壁分别行内镜下PEG胃造瘘及针刀胃造瘘(两瘘口相距2 cm),瘘口长1.5 cm,内镜进入腹腔进行探查,后均以3个内镜夹闭合瘘口;记录操作耗时、术中并发症;第一组实验犬在操作完成后即刻进行剖腹探查并取胃在体外进行胃抗压测试(0 d组);其他3组实验犬分别在术后第3天(3 d组)、7天(7 d组)及14天(14 d组)处死,进行腹腔探查,观察瘘口愈合、腹腔内粘连情况,并进行瘘口抗压测试.结果实验动物均完成了两种胃造瘘术,虽然PEG胃造瘘术在操作耗时方面长于针刀胃造瘘术[(8.4±2.2)min比(5.3±1.5)min,P＜0.05],但其术中出血的并发症明显减少(6.2%比37.5%,P＜0.01);在瘘口抗压测试方面,0 d组、3 d组及7 d组PEG胃造瘘口和针刀胃造瘘口的平均突破阈值分别为(12.3±2.3)mm Hg比(11.4±2.6)mm Hg(P＞0.05)、(32.4±6.7)mm Hg比(23.7±7.7)mm Hg(P＜0.05)和(76.8±9.6)mm Hg比(52.4±8.8)mm Hg(P＜0.05);14 d组实验动物两种方法胃造瘘口受压均超过160 mm Hg而末发生瘘口破裂.大体病理观察显示,相同时间点PEG方法所形成的瘘口具有更好的愈合表现;所有存活动物无腹腔内出血、周围脏器损伤或感染表现.结论与针刀胃造瘘术相比,PEG胃造瘘术虽操作耗时略有延长,但其具有更好的安全性和术后瘘口愈合更快的明显优势.
목적 대비연구자연강도내경외과(NOTES)중PEG위조루술급침도위조루술재조작과정、병발증급루구유합방면적차이.방법 실험견수궤분위4조,매조4지,매지견위전벽분별행내경하PEG위조루급침도위조루(량루구상거2 cm),루구장1.5 cm,내경진입복강진행탐사,후균이3개내경협폐합루구;기록조작모시、술중병발증;제일조실험견재조작완성후즉각진행부복탐사병취위재체외진행위항압측시(0 d조);기타3조실험견분별재술후제3천(3 d조)、7천(7 d조)급14천(14 d조)처사,진행복강탐사,관찰루구유합、복강내점련정황,병진행루구항압측시.결과 실험동물균완성료량충위조루술,수연PEG위조루술재조작모시방면장우침도위조루술[(8.4±2.2)min비(5.3±1.5)min,P＜0.05],단기술중출혈적병발증명현감소(6.2%비37.5%,P＜0.01);재루구항압측시방면,0 d조、3 d조급7 d조PEG위조루구화침도위조루구적평균돌파역치분별위(12.3±2.3)mm Hg비(11.4±2.6)mm Hg(P＞0.05)、(32.4±6.7)mm Hg비(23.7±7.7)mm Hg(P＜0.05)화(76.8±9.6)mm Hg비(52.4±8.8)mm Hg(P＜0.05);14 d조실험동물량충방법위조루구수압균초과160 mm Hg이말발생루구파렬.대체병리관찰현시,상동시간점PEG방법소형성적루구구유경호적유합표현;소유존활동물무복강내출혈、주위장기손상혹감염표현.결론 여침도위조루술상비,PEG위조루술수조작모시략유연장,단기구유경호적안전성화술후루구유합경쾌적명현우세.
Objective To compare the operation process, complications and access healing between PEG(percutaneous endoscopic gastostomy)-like approach and needle knife incision in natural orifice translumenal endoscopic surgery (NOTES). Methods Sixteen dogs were randomly divied into 4 groups (4 dogs per group), and two1.5 cm in diametre gastostomies (2 cm apart) were performed by PEG-like approach and needle knife incision respectively in each dog's anterior wall of stomach. Each gastrostomy was closed by 3 endoclips after the peritoneal exploration. Time consumption for each gastrotomy and complications were recorded. Leakage pressure was measured for the first group (0 day). The healing of each gastostomy and the peritoneal cavity complications, as well as leakage pressures, were examined for 3 other groups on the 3rd day, 7th day and 14th day after necropsy. Results All experimental animals successfully underwent gastrostomies by PEG-like approach and needle knife incision. Although the time consumption for PEG-like approach was longer than that of needle knife incision (8.4 ± 2. 2 min vs. 5.3 ± 1.5 min, P ＜ 0. 05), the bleeding rate during operation was signifcantly lower (6. 2% vs. 37. 5% , P ＜0. 01). The average leakage pressures for PEG-like approach and needle knife incision on 0 day, 3rd day and 7th day were 12. 3 ± 2. 3 mmHg vs. 11.4 ± 2. 6 mmHg (P ＞ 0. 05), 32. 4 ± 6.7 mmHg vs. 23.7 ± 7. 7 mmHg (P ＜ 0. 05) and 76. 8 ± 9. 6 mmHg vs. 52. 4 ± 8. 8 mmHg (P ＜ 0. 05), respectively. In 14d group, the average leakage pressures for two approaches were both beyond 160 mmHg wihout leakage of the stomach. Gross pathological examination revealed that gastrostomies by PEG-like approach had a better healing than that of needle knife incision at the same time point. No peritoneal bleeding, adjacent organ injury or infection were found during necropy in any survived animals. Conclusion Compared with the needle knife incision, PEG-like approach shows the obvious advantages of greater security and more rapid healing in gastrostomy process in spite of the prolonged time consumption.