CAJ | 학술논문

目的：探索经自然腔道内镜外科手术（NOTES）切口大小的选择以及闭合方法。方法以41例离体猪胃为模型，用针状刀直接切开做入路切口。按切口大小及闭合方法分为4组，A组8例做大切口（长度1．2～2．0cm），直接用内镜夹闭合；B组10例做大切口（长度1．2～2．0cm），用透明帽吸引下内镜夹闭合切口；C组10例做小切口（长度小于或等于1．1cm），直接用内镜夹闭合；D组13例做小切口（长度小于或等于1．1 cm ），用透明帽吸引下内镜夹闭合切口。闭合完成后行注水测漏试验，比较结果。结果 A组1例闭合良好，7例失败；B组2例闭合良好，8例失败；C组2例闭合良好，8例失败，D组11例闭合良好，2例失败。采用χ2 Fisher确切概率法检验分析各组数据。A组与B组、C组比较，差异无统计学意义（ P＞0．05）。A组与D组比较，B组与D组比较，差异有统计学意义（P＜0．05）。结论 NOTES切口以小于1 cm ，内镜刚好通过为佳，透明帽吸引内镜夹闭合法简单、实用、有效。
목적：탐색경자연강도내경외과수술（NOTES）절구대소적선택이급폐합방법。방법이41례리체저위위모형，용침상도직접절개주입로절구。안절구대소급폐합방법분위4조，A조8례주대절구（장도1．2～2．0cm），직접용내경협폐합；B조10례주대절구（장도1．2～2．0cm），용투명모흡인하내경협폐합절구；C조10례주소절구（장도소우혹등우1．1cm），직접용내경협폐합；D조13례주소절구（장도소우혹등우1．1 cm ），용투명모흡인하내경협폐합절구。폐합완성후행주수측루시험，비교결과。결과 A조1례폐합량호，7례실패；B조2례폐합량호，8례실패；C조2례폐합량호，8례실패，D조11례폐합량호，2례실패。채용χ2 Fisher학절개솔법검험분석각조수거。A조여B조、C조비교，차이무통계학의의（ P＞0．05）。A조여D조비교，B조여D조비교，차이유통계학의의（P＜0．05）。결론 NOTES절구이소우1 cm ，내경강호통과위가，투명모흡인내경협폐합법간단、실용、유효。
Objective To evaluate the feasibility and effectiveness of four closure techniques ,large incision with plastic distal at‐tachment and clip with suction ,1 .1 cm small incision with plastic distal attachment and clip with suction in natural orifice translu‐minal endoscopic surgery(NOTES) .Methods Forty‐one ex vivo porcine stomachs were involved in this research .According to the size of incision and different methods of incision closure ,all ex vivo porcine stomachs were divided into four groups .Group A in‐volved 8 ex vivo porcine stomachs ,their size of incision were 1 .2-2 .0 cm ,and their incisions were closured by a clip closure direct‐ly ;group B involved 10 ex vivo porcine stomachs ,their size of incision were 1 .2-2 .0 cm ,and their incisions were closed by plastic end attachment with suction and clip enclosure technique;group C involved 10 ex vivo porcine stomachs ,their size of incision were smaller than 1 .1 cm ,and their incisions were by a clip closure directly ;group D involved 13 ex vivo porcine stomachs ,their size of incision were smaller than 1 .1 cm ,and closured by plastic end attachment with suction and clip enclosure technique .Stomach leaks were evaluated by leaking studies after the procedure .Results In group A ,1 incision was closed successfully ,7 incisions were clo‐sured unsuccessfully ;in group B ,2 incisions were closed successfully ,8 incisions were closed unsuccessfully ;in group C ,2 incisions were closed successfully ,8 incisions were closured unsuccessfully ;in group D ,11 incisions were closed successfully ,2 incisions were Closured unsuccessfully .Fisher′s exact test showed that group D was significantly related to the success of incision closure .The were significant differences between group A and D ,group B and group D(P<0 .05) .Conclusion Small incision(smaller than 1 cm) and plastic end attachment with suction and clip enclosure technique are optimal in NOTES procedure in this ex vivo porcine stomachs study .