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首页> 外文期刊>Surgical Endoscopy >Randomized blinded trial shows relative thrombocytopenia in natural orifice translumenal endoscopic surgery compared with standard laparoscopy in a porcine survival model.
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Randomized blinded trial shows relative thrombocytopenia in natural orifice translumenal endoscopic surgery compared with standard laparoscopy in a porcine survival model.

机译：随机盲试验显示，在猪存活模型中，自然孔腔内腔镜手术与标准腹腔镜手术相比，血小板减少症相对较少。

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BACKGROUND: Anecdotal reports of natural orifice translumenal endoscopic surgery (NOTES) procedures in patients are emerging. Whether the new procedure truly is less invasive is not known. Perioperative hematologic parameters during NOTES was compared with those during standard laparoscopy. METHODS: For this study, 12 swine were randomized to transgastric peritoneoscopy with air or diagnostic laparoscopy using carbon dioxide. Arterial and venous catheters provided cardiopulmonary parameters and blood draws at baseline and up to 7 days postoperatively. The animals survived for 14 days. Data were analyzed by an investigator blinded to the procedure performed. Treatments were contrasted in terms of the mean outcome using a repeated measures linear model. RESULTS: All experiments were successfully completed. No gastric leak or peritonitis resulted. One NOTES animal died of hemorrhagic gastritis on postoperative day 3 due to bleeding distant from the gastrotomy site. Two animals in the laparoscopy group andone animal in the endoscopy group experienced respiratory compromise requiring disinflation. A widening pulse pressure and lower bladder pressure were observed in the NOTES group compared with the laparoscopy group (p < 0.001). Pre- and postoperative laboratory results showed an increase in the white blood cell count (1,000/ml) from 16.83 +/- 1.94 in the laparoscopy group and 15.17 +/- 0.41 in the NOTES group at baseline to 24.17 +/- 3.25 and 23.33 +/- 3.88, respectively, on postoperative day 7, but no difference between the groups (p = 0.6). The platelet count (1,000/ml) showed a difference between the two groups, changing from 422.5 +/- 97.49 to 446.33 +/- 89.86 in the laparoscopy group and from 368 +/- 105 to 299.5 +/- 161.9 in the NOTES group (p = 0.03). CONCLUSION: Significant differences in measured but not clinically apparent parameters were encountered. A potentially significant thrombocytopenia clinically was encountered in the NOTES group. The physiologic impact of NOTES procedures beyond the absence of abdominal incisions should be investigated further.
机译：背景：有关患者自然孔腔内镜手术（NOTES）程序的传闻不断。目前尚不清楚新手术是否真正具有较小的侵入性。将NOTES期间与标准腹腔镜检查期间的围手术期血液学参数进行比较。方法：对于本研究，将12头猪随机分配至经空气的经胃腹膜镜检查或使用二氧化碳的诊断性腹腔镜检查。动脉和静脉导管可提供基线和术后长达7天的心肺参数和血液抽取。这些动物存活了14天。数据由不了解所执行程序的研究人员进行分析。使用重复测量线性模型将治疗的平均结果进行对比。结果：所有实验均成功完成。没有导致胃漏或腹膜炎。术后3天，一只NOTES动物死于出血性胃炎，原因是出血远离胃切除部位。腹腔镜检查组的两只动物和内窥镜检查组的一只动物出现呼吸衰竭，需要通气。与腹腔镜检查组相比，NOTES组观察到脉搏压力增高和膀胱压力降低（p <0.001）。术前和术后实验室结果显示，腹腔镜检查组白细胞计数（1,000 / ml）从基线时的16.83 +/- 1.94和NOTES组中的15.17 +/- 0.41增加到基线时的24.17 +/- 3.25和23.33术后第7天分别为+/- 3.88，但两组之间无差异（p = 0.6）。血小板计数（1,000 / ml）显示两组之间存在差异，腹腔镜检查组从422.5 +/- 97.49变为446.33 +/- 89.86，NOTES组从368 +/- 105变为299.5 +/- 161.9 （p ＝ 0.03）。结论：在测量参数上存在显着差异，但在临床上未见明显参数。 NOTES组在临床上遇到了潜在的血小板减少症。在没有腹部切口的情况下，NOTES手术的生理影响应进一步研究。

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