重庆医学
重慶醫學
중경의학
CHONGQING MEDICAL JOURNAL
2014年
24期
3204-3205,3209
,共3页
杨勇致%景宇%黄兴兰%潘雪萍%唐云淑%罗阔%曹宇%宋晓雪%吴世友%梁爽%何德沛
楊勇緻%景宇%黃興蘭%潘雪萍%唐雲淑%囉闊%曹宇%宋曉雪%吳世友%樑爽%何德沛
양용치%경우%황흥란%반설평%당운숙%라활%조우%송효설%오세우%량상%하덕패
经自然腔道内镜外科手术%切口入路
經自然腔道內鏡外科手術%切口入路
경자연강도내경외과수술%절구입로
natural orifice transluminal endoscopic surgery (NOTES)%incision approach
目的：探索经自然腔道内镜手术（NOTES）切口入路的选择及初步尝试NOTES。方法以标准胃镜、肠镜为实验软式内镜，以3条中华田园犬为模型，分别经食道-胃、直肠、脐入路，行腹腔探查、肝活检、膀胱活检、胆囊切除术，比较各种入路的空间方位感、内镜自由度和图像感以判断内镜的操控性。结果3种入路相比较，经食道-胃、直肠入路，内镜的自由度和操控性优于经肚脐入路，腹腔探查术、肝活检术、膀胱活检术均顺利完成，胆囊切除术因暴露不佳，胆囊三角分离困难失败。结论上腹部自然腔道内镜手术入路选择直肠入路，下腹部自然腔道内镜手术入路选择胃-食道入路，可获得好的操控性。用标准胃肠镜做NOTES ，腹腔探查、组织活检等简单检查治疗均可顺利完成，但复杂手术仍需研发新设备，寻求新方法。
目的：探索經自然腔道內鏡手術（NOTES）切口入路的選擇及初步嘗試NOTES。方法以標準胃鏡、腸鏡為實驗軟式內鏡，以3條中華田園犬為模型，分彆經食道-胃、直腸、臍入路，行腹腔探查、肝活檢、膀胱活檢、膽囊切除術，比較各種入路的空間方位感、內鏡自由度和圖像感以判斷內鏡的操控性。結果3種入路相比較，經食道-胃、直腸入路，內鏡的自由度和操控性優于經肚臍入路，腹腔探查術、肝活檢術、膀胱活檢術均順利完成，膽囊切除術因暴露不佳，膽囊三角分離睏難失敗。結論上腹部自然腔道內鏡手術入路選擇直腸入路，下腹部自然腔道內鏡手術入路選擇胃-食道入路，可穫得好的操控性。用標準胃腸鏡做NOTES ，腹腔探查、組織活檢等簡單檢查治療均可順利完成，但複雜手術仍需研髮新設備，尋求新方法。
목적：탐색경자연강도내경수술（NOTES）절구입로적선택급초보상시NOTES。방법이표준위경、장경위실험연식내경，이3조중화전완견위모형，분별경식도-위、직장、제입로，행복강탐사、간활검、방광활검、담낭절제술，비교각충입로적공간방위감、내경자유도화도상감이판단내경적조공성。결과3충입로상비교，경식도-위、직장입로，내경적자유도화조공성우우경두제입로，복강탐사술、간활검술、방광활검술균순리완성，담낭절제술인폭로불가，담낭삼각분리곤난실패。결론상복부자연강도내경수술입로선택직장입로，하복부자연강도내경수술입로선택위-식도입로，가획득호적조공성。용표준위장경주NOTES ，복강탐사、조직활검등간단검사치료균가순리완성，단복잡수술잉수연발신설비，심구신방법。
Objective The optimal access for natural orifice transluminal endoscopic surgery is still uncertain .This study was designed to compare the practicability and maneuverability of transgastric ,transunmbilical ,and transrectal approach in abdominal surgery in a canine model .Methods Three dogs were used in this research .Three approach :trangastric ,transunmbilical and tran-srectal approach were carried out for abdominal exploration ,liver biopsy ,bladder biopsy and an attempted cholecystectomy .The ma-neuverability ,endoscopic image ,performer′s perception ,and spatial orientation were evaluated .Results The maneuverability of trangastric ,and transrectal approach NOTES were better than transunmbilical NOTES .Abdominal exploration ,live biopsy ,and bladder biopsy were completed successfully .The cholecystectomy was failed because of poor exposure and difficulty of separating the around tissure .Conclusion The optimal approach for upper abdomen NOTES is transrectal route .For lower abdomen NOTES , the trangastric approach is superior to other accesses .Further study is needed to develop more flexible and precise equipment for NOTES and to evaluate more feasible access approach .
