Hookey L C, Khokhotva V, Bielawska B, Samis A, Jalink D, Hurlbut D, Mercer D
Gastrointestinal Diseases Research Unit - GI, Queen's University, Queen's University Hotel Dieu Hospital, Kingston, Ontario, Canada.
Endoscopy. 2009 Feb;41(2):149-53. doi: 10.1055/s-0028-1119464. Epub 2009 Feb 12.
Finding a reliable, safe, adaptable method of closing gastrotomies for natural-orifice transluminal endoscopic surgery (NOTES) procedures has been a major challenge facing this new clinical area. The Queen's NOTES Group has designed a novel endoscopic method of closing gastrotomies which involved using PolyLoop polyp ligature devices and endoscopic clips. The current study describes the technique and a pilot study of leak testing it versus hand-sewn suture closure.
Ten fresh pig stomachs were used, five for each technique. A 16-mm endoscopic gastrotomy was performed on the anterior wall of each. Five stomachs were then closed using the Queen's closure technique, and five with a hand-sewn double-layer suture technique. The stomachs were then connected to a water infusion device with sensitive pressure monitoring and were filled until leakage was detected at the closure site.
The closures were all technically successful. The mean time for each gastrotomy and closure using the Queen's closure technique was 1.2 hours. The mean leak pressure for the Queen's closure was 51.8 mmHg and for the hand-sewn suture technique it was 80.8 mmHg ( P < 0.001).
The Queen's closure technique holds promise as a reliable transferable technique for closing gastrotomies. Further study is necessary to evaluate its effects in live models.
为自然腔道内镜手术（NOTES）找到一种可靠、安全且适用的胃切开术闭合方法，一直是这一新兴临床领域面临的重大挑战。女王NOTES研究小组设计了一种新型的内镜下胃切开术闭合方法，该方法使用PolyLoop息肉结扎装置和内镜夹。本研究描述了该技术，并对其与手工缝合关闭进行渗漏测试的初步研究。
使用10个新鲜猪胃，每种技术各用5个。在每个猪胃的前壁进行16毫米的内镜胃切开术。然后，5个胃采用女王闭合技术进行闭合，另外5个采用手工双层缝合技术进行闭合。接着将胃连接到带有灵敏压力监测的注水装置上，注水直至在闭合部位检测到渗漏。
所有闭合操作在技术上均获成功。采用女王闭合技术进行每次胃切开术和闭合的平均时间为1.2小时。女王闭合技术的平均渗漏压力为51.8毫米汞柱，手工缝合技术的平均渗漏压力为80.8毫米汞柱（P < 0.001）。
女王闭合技术有望成为一种可靠的、可推广的胃切开术闭合技术。有必要进一步研究以评估其在活体模型中的效果。
