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目的探讨NOTES完成动物腹部多种手术成功与失败的原因,为其应用于临床提供实验依据。方法回顾分析2007年8月～2009年9月完成的全部动物实验数据。研究分为急性实验和存活实验2部分,采用雌性小型猪和成年杂种犬,分别开展了单纯NOTES和腹腔镜辅助的NOTES。进行诊断性腹腔探查和肝脏活检术,治疗性胆囊切除、输卵管结扎切除、卵巢切除、脾切除和胃空肠吻合等腹部手术。记录术中和术后并发症的发生情况,以及操作过程中遇到的技术难题。结果采用37只小型猪和16只杂种犬,完成急性实验22例,存活实验31例。共开展各种NOTES手术91例次,其中单一经胃路径25例次,单一经结肠路径8例次,经胃和结肠联合路径16例次,经胃和阴道联合路径6例次,传统腹腔镜辅助经胃路径26例次,单孔腹腔镜辅助经胃路径10例次。完成诊断性腹腔探查术33例,成功率100%(33/33),肝脏活检术11例,成功率100%(11/11),输卵管结扎切除术11例,成功率100%(11/11),卵巢切除术6例,成功率100%(6/6),胆囊切除术27例,成功率44.4%(12/27)。另行脾切除术1例和胃空肠吻合术2例,均未成功。总的并发症发生率为39.6%(21/53),其中穿孔8例,脏器损伤5例,出血4例,腹腔感染3例,腹压过高导致动物死亡1例。结论NOTES用于诊断性腹腔探查和简单治疗是安全有效的,但完成腹部较复杂的手术尚不可行。腹腔镜辅助NOTES的方法或许是此项技术从动物实验过渡到临床应用的桥梁。
Objective To explore the reasons for the success and failure of NOTES in various abdomen operations and to provide experimental evidence for its application in clinical practice. Methods The data of all animal experiments completed from August 2007 to September 2009 were retrospectively analyzed. The study was divided into two parts: Acute and Survival experiments. Female NOT pigs and adult dogs were used to carry out simple NOTES and laparoscopic-assisted NOTES respectively. Diagnostic abdominal exploration and liver biopsy, therapeutic cholecystectomy, tubal ligation, ovariectomy, splenectomy and gastrojejunostomy abdominal surgery. Record the occurrence of intraoperative and postoperative complications, as well as technical problems encountered in the operation. Results A total of 37 miniature pigs and 16 mongrel dogs were used in this study. Twenty-two acute cases and 31 surviving cases were completed. A total of 91 cases of various NOTES operations were performed, of which 25 were single transabdominal routes, 8 transnasal colon routes, 16 via stomach and colon combined routes, 6 via gastric and vaginal routes, and conventional laparoscopy Assisted by the gastric route in 26 cases, single hole laparoscopic assisted transabdominal route in 10 cases. Thirty-three cases of diagnostic celiac exploration were completed, the success rate was 100% (33/33), liver biopsy was performed in 11 cases, the success rate was 100% (11/11), tubal ligation and resection in 11 cases, the success rate was 100% ), Ovariectomy in 6 cases, the success rate of 100% (6/6), cholecystectomy in 27 cases, the success rate of 44.4% (12/27). Another case of splenectomy and gastrojejunostomy in 2 cases, were unsuccessful. The total complication rate was 39.6% (21/53). There were 8 cases of perforation, 5 cases of organ injury, 4 cases of hemorrhage, 3 cases of intra-abdominal infection and 1 case of animal death caused by excessive abdominal pressure. Conclusions NOTES is safe and effective for diagnostic and simple peritoneal exploration. However, it is not feasible to perform complicated abdominal surgery. The method of laparoscopic-assisted NOTES may be the bridge from the animal experiment to the clinical application of this technique.