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可调节尼龙圈荷包闭合法在经自然腔道内镜外科手术中的应用

(2014-10-22 12:27:37)

    作者单位:710032 西安,第四军医大学西京医院消化内科

    [摘要]目的  评价可调节尼龙圈荷包闭合术在经自然腔道内镜外科手术(NOTES)切口关闭中的可行性和安全性。方法  本研究采用10只健康雌性犬模型。分别在5组(每组2只)犬中进行不同部位的(胃窦大弯侧,胃体小弯侧和大弯侧,胃体前壁和后壁)NOTES腹腔探查术。探查术后利用尼龙圈荷包闭合法关闭胃壁切口。术后2周通过胃镜、解剖、细菌培养及组织学检验评估腹腔感染和切口愈合情况。结果  10只动物均成功完成NOTES腹腔探查术及荷包闭合术。荷包闭合术平均操作时间为(7.3±1.8min。术中有2只动物在胃窦和胃体大弯侧切开过程中出现微量出血,经电凝处理后出血停止。除1只动物在切口处发现单纯网膜粘连,其余动物的腹水细菌培养及解剖均未发现腹腔感染等其他并发症。内镜、解剖及组织学检查结果均提示切口完全愈合。结论  使用可调节尼龙圈荷包闭合法关闭NOTES胃切口是安全可行和简便的。该方法适用于多部位胃切口的关闭,理论上可用于医源性胃穿孔的修补。

    [关键词] 模型,动物;胃;切口;尼龙;缝合技术

    Adjustable loop-based purse-string technique in NOTES gastrotomy closure   LUO Hui, PAN Yang-lin, MIN Lei, LU Min, XUE Ling, GUO Xue-gang. Department of Gastroenterology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, China

    Corresponding author: Guo Xue-gang, Email: gxuegang@fmmu.edu.cn

    [Abstract]Objective   To assess the feasibility and safety of adjustable loop-based purse-string technique in gastrotomy closure of natural orifice translumenal endoscopic surgery (NOTES). Methods   Ten healthy female dogs were used in this study. Transgastric NOTES peritoneal exploration was performed in 5 groups (2 dogs in each) via various sites of the stomach (greater curvature of the antrum; greater and lesser curvature of the body; anterior and posterior wall of the body). The gastric incision was then closed by using loop-based purse-string technique. Healing of the incision and intra-peritoneal infection were checked by endoscopy, necropsy, bacterial culture and histological examination 2 weeks later. Results   The performance of NOTES peritoneal exploration and closure with purse-string technique was successful in ten dogs without significant complications. The mean operation time of closure was 7.3±1.8 min. Minor bleeding occurred in 2 dogs (20%) during the incision of greater curvature of the antrum and body, which was controlled by electrocoagulation. Culture of the ascitic fluid and necropsy revealed no sign of abdominal infection or other complications except for adhesion in 1 dog (10%). The intact incision was confirmed by endoscopic, postmortem and histological examination, which suggested complete healing of the incision. Conclusion   It is easy and safe to use loop-based purse-string technique for closure of multi-regional NOTES gastrotomy. This technology may be used for the repair of gastric ulcer perforation theoretically.

    [Key words]  Models,animal;StomachIncision;Nylons;Suture techniques

     

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个人资料
    郭学刚 单位:第四军医大学西京医院
    所属科室:消化六科
    出生:1964-03-10
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