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采用经肛内镜缝合术与环形吻合器行经直肠内脏切口闭合的前瞻性实验研究:迈向经直肠自然腔道内镜手术的一步

发布日期:2014-1-29 12:40:43 文章来源:ENDOSCOPY 作者次数:1189
    采用经肛内镜缝合术与环形吻合器行经直肠内脏切口闭合的前瞻性实验研究:迈向经直肠自然腔道内镜手术的一步

    M. Diana1, J. Leroy1, J. Wall1, V. De Ruijter1, V. Lindner2, P. Dhumane1, D. Mutter1, J. Marescaux1

    1IRCAD/EITS研究所、法国斯特拉斯堡大学医院普外科、消化内科和内分泌科

    2法国米卢斯医院病理科

    背景与研究目的:直肠壁腔内全层封闭在包括内镜黏膜下剥离术和经直肠自然腔道内镜手术(NOTES)在内的新兴手术中是关键的。本研究旨在比较采用经肛内镜手术平台(TEO;德国Karl StorzTüttlingen)和端对端吻合痔环形吻合器(EEA;爱尔兰都柏林Covidien)进行的手工缝合术,以封闭经直肠自然腔道内镜手术阶段性结肠切除过程中所致的直肠切口。

    材料与方法:共12头猪接受了经直肠混合NORES部分结肠切除术。根据内脏切口缝合技术,即TEO手工缝合和EEA环形吻合器缝合,将动物分成两组。

    结果:采用TEO EEA的平均(±标准差)内脏切口缝合时间分别为67.5 ± 59.531.5 ± 19.6分。TEO组有一次换为腹腔镜检查,EEA组有一次失败,需TEO救助缝合。每组各出现一次漏气试验。手术结束时收集的所有案例的腹腔液细菌污染测试呈阳性。TEO67%4 /6)的内脏切口出现轻度狭窄,EEA组依靠内镜控制,有17%1/6)的内脏切口出现轻度狭窄。TEOEEA组分别有3/560 %)和4/5 80 %)的内脏切口表现出轻度炎症变化,然而TEO组和EEA组分别有2/5 1 /5的内脏切口表现出重度炎症。

    结论:采用EEA环形吻合器技术行经直肠内脏切口闭合是可行的且易于实施,从组织学上来看,它比得上采用TEO平台进行的修补缝合术。它可能提供了一个更具有吸引力的NOTES节段性结肠切除术和内镜下切除术的替代方法。

     

     


    Prospective experimental study of transrectal viscerotomy closure using transanal endoscopic suture vs. circular stapler: a step toward NOTES

    M. Diana1, J. Leroy1, J. Wall1, V. De Ruijter1, V. Lindner2, P. Dhumane1, D. Mutter1, J. Marescaux1

    1IRCAD/EITS Institute, Department of General, Digestive and Endocrine Surgery, UniversityHospitalofStrasbourg,Strasbourg,France

    2Department of Pathology,HospitalofMulhouse,Mulhouse,France

    Background and study aim: Endoluminal full-thickness closure of the rectal wall is critical in emerging procedures including endoscopic submucosal dissection and transrectal natural orifice transluminal endoscopic surgery (NOTES). This study aimed to compare manual suture using the transanal endoscopic operation platform (TEO; Karl Storz,Tüttlingen,Germany) with the end-to-end anastomosis hemorrhoid circular stapler (EEA; Covidien,Dublin,Ireland) for closure of the rectal viscerotomy during transrectal NOTES segmental colectomy.

    Materials and methods: A total of 12 swine underwent transrectal hybrid NOTES partial colectomies. Animals were divided into two groups according to the viscerotomy closure technique: 1) TEO manual suture; 2) EEA circular stapler closure.

    Results: Mean (± SD) viscerotomy closure time was 67.5 ± 59.5 minutes and 31.5 ± 19.6 minutes for TEO and EEA, respectively. There was one conversion to laparoscopy in the TEO group and a misfiring in the EEA group that required a TEO salvage suture. There was one positive air-leak test in each group. Peritoneal fluid collected at the end of the procedure tested positive for bacterial contamination in all cases. A mild stenosis was present in 4 /6 viscerotomies (67 %) in the TEO group and in 1/6 (17 %) in the EEA group on endoscopic control. Inflammatory changes were mild in 3/5 (60 %) and 4/5 (80 %) viscerotomies in the TEO and EEA groups, respectively, whereas severe inflammation was found in 2/5 (TEO) and 1 /5 (EEA).

    Conclusion: Transrectal viscerotomy closure using the EEA circular stapler technique is feasible, easy to perform, and histologically comparable to suture closure through a TEO platform. It may offer an attractive alternative for NOTES segmental colectomies and endoscopic resections.

     

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