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首页> 外文期刊>Surgical Endoscopy >Natural orifice transesophageal mediastinoscopy and thoracoscopy: a survival series in swine.
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Natural orifice transesophageal mediastinoscopy and thoracoscopy: a survival series in swine.

机译：天然口经食道纵隔镜和胸腔镜：猪的生存系列。

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INTRODUCTION: Transesophageal endoscopic mediastinoscopy (MX) and thoracoscopy (TX) could reduce pain, eliminate intercostal neuralgia, provide better access to the posterior mediastinal compartment and pulmonary hilum, and improve cosmesis. The purpose of this study was to demonstrate the feasibility of transesophageal natural orifice translumenal endoscopic surgery (NOTES) and to determine the complications that might be seen in surviving animals. METHODS: Using cap endoscopic mucosal resection and blunt dissection, a 15-20 cm submucosal tunnel was created in the esophagus and an endoscope passed through the tunnel into the mediastinum. One swine underwent MX; three swine underwent both MX and TX. The mediastinal compartment, hilar lymph nodes, pleura, lung, and esophagus were identified. Esophageal closure was obtained via submucosal tunnel flap-valve alone (two swine) or reinforcement with mucosal clips (two swine). The esophagus, mediastinum, and thorax were examined at necropsy. The esophagus wasexcised and sent for pathological examination. RESULTS: NOTES MX and TX provided excellent visualization of mediastinal and thoracic structures. Pleural biopsy was easily accomplished. All animals survived the procedure, ate well, and showed no ill effects. Swine were sacrificed at either 8 or 12 days postoperatively. At necropsy, mild atelectasis was noted in each animal. One animal (mucosal clip closure) developed a fluid collection in the submucosal tunnel. There was no evidence of mediastinitis or thoracic contamination in any animals. CONCLUSIONS: Transesophageal endoscopic mediastinoscopy and thoracoscopy provide excellent visualization of mediastinal and intrathoracic structures. Pleural biopsy can be easily obtained under direct visualization. Structures that are difficult to visualize via traditional cervical mediastinoscopy and thoracoscopy are seen well with this approach. The submucosal tunnel creates a flap-valve that, alone, may be sufficient for preventing esophageal leak. These procedures can be performed safely in swine with short-term survival. Further study with a larger sample size and longer survival is warranted.
机译：简介：经食道内镜纵隔镜（MX）和胸腔镜（TX）可以减轻疼痛，消除肋间神经痛，更好地进入后纵隔室和肺门，并改善美容效果。这项研究的目的是证明经食道自然孔腔内腔镜手术（NOTES）的可行性，并确定存活动物中可能出现的并发症。方法：使用帽内窥镜黏膜切除术和钝性剥离术，在食道中创建了一个15-20 cm的黏膜下隧道，并且内窥镜通过隧道进入纵隔。一只猪接受了MX治疗;三头猪同时接受了MX和TX。确定了纵隔室，肺门淋巴结，胸膜，肺和食道。通过单独的粘膜下隧道瓣瓣膜（两只猪）或通过粘膜夹加固（两只猪）获得食管闭合。尸检时检查食道，纵隔和胸部。切除食道并送去进行病理检查。结果：注意MX和TX提供了纵隔和胸腔结构的出色可视化。胸膜活检很容易完成。所有动物均存活下来，饮食良好，没有不良反应。术后8或12天处死猪。尸检时，每只动物均出现轻度肺不张。一只动物（粘膜夹闭合）在粘膜下隧道中形成了积液。没有任何动物有纵隔炎或胸腔污染的证据。结论：经食道内镜纵隔镜和胸腔镜可以很好地观察纵隔和胸腔内结构。胸膜活检可在直接观察下轻松获得。用这种方法可以很好地看到传统的宫颈纵隔镜和胸腔镜难以观察到的结构。粘膜下通道形成了一个瓣阀，仅此一个瓣阀就足以防止食道渗漏。这些程序可以在具有短期生存期的猪中安全地执行。需进行更大样本量和更长生存期的进一步研究。

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