NOTES技术在腹腔探查中应用的动物实验研究

发布时间：2018-05-04 22:40

本文选题：经自然腔道手术 + 腹腔探查　；参考：《吉林大学》2012年硕士论文

【摘要】：背景：腹腔探查术是医生用来探查腹腔疾病病因或明确病变程度而普遍采用的一种检查和治疗方法。许多外科医生在临床工作中都会偶尔遇到不明原因的腹痛，无法确定的诊断及可疑的腹腔内肿块，目前临床开展的许多无创检查。例如腹部B超、CT、MR等对于微小病变诊断效果差，仅能发现直径5-10mm以上的腹腔内肿物。且辅助检查结果不能定性，仅起到提示作用，这样容易造成小病变的漏诊及误诊，例如对结核性腹膜炎、转移到腹膜的肿瘤等常不能提示。而这些病人往往无特异性临床表现,行常规内科检查无法及时准确诊断病因,尤其是找不到原因的腹水患者，这不仅容易延误病情也加重了病人经济负担。在这种情况下，，腹腔探查作为一种非常有效,重要的手段常常可以帮助医生明确诊断。腹腔探查的方式很对，其中开腹探查、腹腔镜探查在技术上已经非常成熟，而应用NOTES技术行腹腔探查则是一种新兴的腹腔探查方式。其在腹腔探查及靶向取活检方面可显示出其独特的优势。本研究在总结前人经验基础上，在现有的技术及条件下利用实验猪模型对NOTES在腹腔探查及定向活检方面的可行性及价值做出评价。目的：腹腔探查及定向活检是诊断腹部疾病非常有效地一种手段，传统的方式对病人损伤大，费用高，病人难以接受。本研究只在评价NOTES在腹腔探查及取活检中的可行性及应用价值。方法：对3只雌性家猪依据不同入路分组并做好术前准备。术中给予深度麻醉，监护心电、血氧。术者分别从胃入路、肠入路、阴道入路建立切口，进入内镜，对拟定脏器行探查、取活检并留取图片。术后立即解剖，对各个脏器拍照。结果：实验动物经过禁食及药物处理胃肠道排空情况尚可。在拟定位置顺利完成造口，未发生造口出血。不同入路造口耗费时间及操作难度不同。直肠及阴道入路操作相对容易，造口耗费时间最短；胃入路操作难度大，耗时最长。术后剖腹观察未发现造口周围脏器损伤。气腹建立耗时约10分，完全满足探查视野需要。经胃入路对下腹部脏器如膀胱、卵巢、输卵管观察效果好。翻转镜身时可观察到部分肝脏、胃、胆囊、脾脏及膈肌。经肠及经阴道入路的观察范围几乎一致。对上腹部脏器如肝脏、胆囊、脾脏、胃、膈肌的观察效果理想，可以看见全部，但是探查肝脏的膈肌面操作难度较大。对于下腹部脏器的探查需要翻转镜身，探查仅见部分膀胱，卵巢、输卵管。三种入路对腹膜后脏器肾脏、输尿管、胰腺探查均未成功；对大小肠、大网膜、壁层腹膜探查效果无明显差别，均全部可见。对所见脏器均可顺利进行靶向活检，但同一脏器在不同入路下活检术难度不同。结论：NOTES在腹腔探查及靶向活检方面具有巨大优势和潜力，不同入路之间对拟定脏器探查范围存在差异，应根据拟探查脏器选择适宜的入路。
[Abstract]:Background: celiac exploration is a common method used by doctors to investigate the etiology or degree of celiac diseases. Many surgeons occasionally encounter unknown abdominal pain, uncertain diagnosis and suspected abdominal mass in their clinical work. For example, CT Mr of abdominal ultrasound is not effective in the diagnosis of minor lesions, and can only detect intraperitoneal masses larger than 5-10mm in diameter. And the results of auxiliary examination can not be qualitative, only play a role in prompting, so it is easy to cause small lesions of missed diagnosis and misdiagnosis, such as tuberculous peritonitis, metastasis to the peritoneal tumor and other often can not be prompted. But these patients often have no specific clinical manifestations, routine medical examination can not be timely and accurate diagnosis of the etiology, especially the ascites patients who can not find the cause, which is not only easy to delay the disease but also increase the economic burden of patients. In such cases, abdominal exploration is a very effective and important tool that often helps doctors to make a diagnosis. The technique of laparoscopy and laparoscopy is very mature, and the application of NOTES is a new way of abdominal exploration. It can show its unique advantages in abdominal exploration and targeted biopsy. On the basis of summarizing the previous experiences, the feasibility and value of NOTES in abdominal cavity exploration and directed biopsy were evaluated by using experimental pig model under the existing technology and conditions. Objective: abdominal exploration and directed biopsy are very effective methods for the diagnosis of abdominal diseases. The purpose of this study was to evaluate the feasibility and value of NOTES in abdominal cavity exploration and biopsy. Methods: three female pigs were divided according to different approaches and prepared for operation. Deep anesthesia, monitoring of ECG and blood oxygen were given during the operation. Incision was established from gastric approach, intestinal approach, vagina approach, and endoscopy, and the viscera was explored, biopsies were taken and pictures were taken. All organs were dissected immediately after operation. Results: the gastrointestinal emptying of experimental animals after fasting and drug treatment was good. The anastomosis was completed successfully in the proposed position, and no bleeding occurred. The time and difficulty of operation are different in different ways. The operation of rectal and vaginal approach is relatively easy, and the operation time is the shortest; the gastric approach is difficult and time-consuming. No visceral injury around the orifice was found in postoperative laparotomy. The establishment of pneumoperitoneum takes about 10 years and completely meets the needs of exploratory visual field. The effect of transgastric approach on lower abdominal organs such as bladder, ovary and fallopian tube is good. Part of the liver, stomach, gallbladder, spleen and diaphragm can be observed when turning the mirror body. The observed range of transintestinal and transvaginal approaches was almost the same. The observation of upper abdominal organs such as liver, gallbladder, spleen, stomach and diaphragm is ideal and can be seen completely, but the operation of exploring the diaphragm surface of liver is difficult. For the exploration of the lower abdomen viscera, only part of the bladder, ovary, fallopian tube should be turned over. The three approaches were not successful in the exploration of retroperitoneal organs, kidneys, ureters and pancreas, but there was no significant difference in the results of exploration of large intestine, omentum and parietal peritoneum, all of which could be seen. All the viscera were successfully performed targeted biopsy, but the same organ had different difficulty under different approaches. ConclusionWhile notes has great advantages and potential in abdominal cavity exploration and targeted biopsy, there are differences in the range of visceral exploration between different approaches, and the appropriate approach should be selected according to the intended exploration.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R656;R-332

【二级参考文献】