经自然管壁内镜手术胆囊切除术动物实验

Natural orifice translumenal endoscopic cholecystectomy: Animal model

  • 摘要: 目的 探讨单孔腹腔镜辅助下自然管壁内镜手术(NOTES)胆囊切除术的操作方法、可行性及安全性。方法 采用成年杂种犬模型10只。先后完成内镜下胃造口术、腹腔探查、经脐单孔腹腔镜辅助下胆囊暴露及内镜下胆囊切除术。术后钛夹闭合胃壁切口,常规应用抗生素3d,半流食饲养。2周后处死模型解剖,观察胆囊切除术后改变。结果 8只模型胆囊切除术后存活2周,1只实验中死亡,1只存活1周后死于腹腔脓肿,成功率80%(8/10)。平均用时80min/例次(40-150min),术中肝脏出血应用电凝止血4次,钛夹闭合1次;胆囊及胆囊管残端漏各1次,用钛夹闭合成功。存活两周模型解剖胃壁造口完整闭合,腹腔无脓肿。结论 杂种犬能较好模拟人体进行内镜胆囊切除术研究,经脐戳孔辅助经胃途径胆囊切除术是可行的,具有一定的安全性,目前的器械和设备尚不能满足NOTES技术需要,还有待研发。

     

    Abstract: Objective To study the manipulation,feasibility and safety of natural orifice translumenal endoscopic cholecystectomy in animal models. Methods Ten mongrel dogs were involved in this study.Endoscopic gastrostomy,laparoscopy,transumbilical single orifice endoscopic cholecystectomy were performed.The incision on gastric wall was closed and antibiotics were routinely used.The animals were fed with semi-liquid diet.Two weeks after operation,the animals were sacrificed to observe the changes occurred after cholecystectomy. Results Of the 10 dogs,8 survived for 2 weeks after operation with a success rate of 80%(8/10),1 died during operation,and 1 died 1 week after operation due to abdominal abscess.The average operation time was 80 min(range 40-150min).Hemostasis was performed 4 times with electric coagulation and once with clips for liver bleeding during the operation.Leakage occurred in the residual end of gallbladder and cystic ducts and was closed with clips.The incision was completely healed with no abdominal abscess in those that survived for 2 weeks after operation. Conclusion Mongrel dogs can be used as the model of translumenal cholecystectomy in humans.Transumbilical single orifice endoscopic cholecystectomy is feasible and relatively safe.Surgical instruments cannot meet its requirements and remain to be developed.

     

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