论文部分内容阅读
目的探索经自然腔道内镜手术(NOTES)切口入路的选择及初步尝试NOTES。方法以标准胃镜、肠镜为实验软式内镜,以3条中华田园犬为模型,分别经食道-胃、直肠、脐入路,行腹腔探查、肝活检、膀胱活检、胆囊切除术,比较各种入路的空间方位感、内镜自由度和图像感以判断内镜的操控性。结果 3种入路相比较,经食道-胃、直肠入路,内镜的自由度和操控性优于经肚脐入路,腹腔探查术、肝活检术、膀胱活检术均顺利完成,胆囊切除术因暴露不佳,胆囊三角分离困难失败。结论上腹部自然腔道内镜手术入路选择直肠入路,下腹部自然腔道内镜手术入路选择胃-食道入路,可获得好的操控性。用标准胃肠镜做NOTES,腹腔探查、组织活检等简单检查治疗均可顺利完成,但复杂手术仍需研发新设备,寻求新方法。
Objective To explore the choice of NOTES incision approach and NOTES. Methods Standard gastroscopy and colonoscopy were used as soft endoscopes. Three Chinese idioms were used as the model, and were respectively transesophageal-gastric, rectal and umbilical approaches, abdominal exploration, liver biopsy, bladder biopsy and cholecystectomy. The spatial orientation of various approaches, endoscopic freedom and image perception to determine the endoscopic manipulation. Results Compared with the three kinds of approaches, the degrees of freedom and maneuverability of the endoscopy, transabdominal esophagectomy, biopsy, biopsy and biopsy were better than those of the transurethral esophagus through the approach of esophagus, stomach and rectum. Cholecystectomy Due to poor exposure, gallbladder triangle separation failure difficult. Conclusions The endoscopic approach to natural laparoscopic surgery in the upper abdomen selects the rectal approach, and the natural laparoscopic surgery in the lower abdomen selects the gastro-esophageal approach to achieve good maneuverability. With standard gastrointestinal endoscopy NOTES, abdominal exploration, biopsy and other simple examination and treatment can be successfully completed, but the complex operation still need to develop new equipment, to find new ways.