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首页> 外文期刊>Gastrointestinal Endoscopy >Evaluation of endoscopy in localizing transgastric access for natural orifice transluminal endoscopic surgery in humans.
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Evaluation of endoscopy in localizing transgastric access for natural orifice transluminal endoscopic surgery in humans.

机译：内窥镜在人体自然孔腔内腔镜手术中定位胃定位的评估。

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BACKGROUND: To date, transgastric access in humans for natural orifice transluminal endoscopic surgery (NOTES) has been poorly evaluated. OBJECTIVE: To compare endoscopic visualization of the transgastric access point with the laparoscopically defined ideal entrance to the peritoneal cavity. DESIGN: Prospective pilot study in humans. SETTING: Single tertiary-care center. PATIENTS: This study involved 31 patients referred for laparoscopic cholecystectomy. INTERVENTION: Access points were marked by endoscopy alone, endoscopy combined with diaphanoscopy, and endoscopy after pneumoperitoneum. Points were correlated with a laparoscopically visualized, previously defined ideal access area. MAIN OUTCOME MEASUREMENTS: To choose the appropriate access point within the laparoscopically defined ideal access area to the peritoneal cavity away from major vessels and adjacent organs, by using endoscopy and to establish landmarks for the endoscopist, look for a learning curve, and identify potential problems. RESULTS: The percentage of access points within the laparoscopically defined ideal area was 35.5% with endoscopy alone, 13.8% using the diaphanoscopy method, and 45.2% after transcutaneous pneumoperitoneum. A safe access point (> or = 3 cm from major gastric vessels) could be achieved with the 3 techniques in 83.9%, 65.5%, and 87.1% of patients, respectively. A positive learning curve for endoscopic localization was identified before (P = .008) and after (P = .014) pneumoperitoneum. Virtual complications were greater in obese patients. LIMITATIONS: This was a small pilot study with hypothetical complications and problems, because actual transgastric access was not performed. The criteria for an ideal access area were very strict. CONCLUSION: Endoscopy, especially with the use of pneumoperitoneum, can reliably locate a safe transgastric entrance point. However, the endoscopically chosen site correlates poorly with the ideal laparoscopically determined site for transgastric access.
机译：背景：迄今为止，对于自然孔腔内腔镜手术（NOTES）的人经胃通路的评估很差。目的：比较经胃进入点的内窥镜检查与腹腔镜确定的腹膜腔理想入口的比较。设计：人体前瞻性研究。地点：单一三级护理中心。患者：本研究涉及31例因腹腔镜胆囊切除术而转诊的患者。干预措施：仅通过内窥镜检查，内窥镜检查结合腹膜镜检查和气腹后内窥镜检查可对接入点进行标记。将点与腹腔镜可视化的先前定义的理想通路区域相关联。主要观察指标：通过使用内窥镜检查，在腹腔镜定义的理想腹膜腔内选择远离腹膜腔，远离主要血管和邻近器官的合适的进入点，并为内镜医师建立界标，寻找学习曲线并找出潜在的问题。结果：仅通过内窥镜检查，腹腔镜检查确定的理想区域内的接入点百分比为35.5％，采用透照检查法为13.8％，经皮气腹手术后为45.2％。通过这三种技术，可以分别在83.9％，65.5％和87.1％的患者中实现安全的接入点（距主要胃血管> = 3 cm）。在气腹前（P = .008）和术后（P = .014），确定了内镜定位的阳性学习曲线。肥胖患者的虚拟并发症更大。局限性：这是一项小型假想研究，假设有并发症和问题，因为未进行实际的经胃入路。理想进入区域的标准非常严格。结论：内窥镜检查，尤其是与气腹配合使用，可以可靠地确定安全的经胃进入点。然而，内窥镜选择的部位与经腹腔镜确定的经胃通路的理想部位相关性较差。

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