Baystate Medical Center, Tufts University School of Medicine, Springfield, MA 01103, USA.
J Pediatr Surg. 2010 Jan;45(1):80-3. doi: 10.1016/j.jpedsurg.2009.10.015.
We present a case report of a novel hybrid natural orifice transluminal endoscopic surgery (NOTES). The operation performed was a transgastric cystgastrostomy with endoscopic guidance for a pancreatic pseudocyst. This operation was completed entirely through an existing gastrostomy site with no incisions, thus avoiding the peritoneal cavity.
This is a case of a 7-year-old boy with neurologic impairment from congenital herpes simplex virus encephalitis who is tube fed. He had acute pancreatitis and developed a 9 cm pancreatic pseudocyst. The pseudocyst failed to resolve after 6 weeks and developed a mature wall. Due to a history of multiple abdominal surgeries and known abdominal adhesions, a minimally invasive approach that would avoid entering the peritoneal cavity was the desired approach. The technique involved a trans-oral endoscope for visualization and the use of the gastrostomy as access to the gastric lumen and pseudocyst. The pancreatic pseudocyst was stabilized with two T-fasteners and confirmed with needle aspiration under endoscopic visualization. The pseudocyst was then opened with the LigaSure (Valleylab, Boulder, CO). The cystgastrostomy anastomosis was completed with an Endopath ETS-Flex Articulating Linear Stapler/Cutter (Ethicon Endo-Surgery, Inc, Cincinnati, OH). The operation took less than 2 hours and was completed without an incision. Under the policies of the Human Research Protection Program, review of a single case is outside the scope of the definition of human subjects research and does not require institutional review board review and approval.
The patient did well postoperatively and had a dramatic reduction in size of the pancreatic pseudocyst to 3.5 cm by 2 weeks.
Hybrid NOTES cystgastrostomy performed through an existing gastrocutaneous fistula is an excellent approach for minimally invasive drainage of pancreatic pseudocysts.
我们报告了一例新型混合经自然腔道内镜外科（NOTES）手术。实施的手术是经胃内镜引导下的胰腺假性囊肿胃囊肿造口术。该手术完全通过现有的胃造口部位进行，无需切口，从而避免了进入腹腔。
这是一例 7 岁男孩，因先天性单纯疱疹病毒脑炎导致神经功能障碍，需要经胃管喂养。他患有急性胰腺炎并发展为 9 厘米的胰腺假性囊肿。该假性囊肿在 6 周后未消退并形成成熟壁。由于多次腹部手术和已知的腹部粘连史，希望采用一种微创方法，避免进入腹腔。该技术涉及经口内镜进行可视化，并使用胃造口作为进入胃腔和假性囊肿的通道。使用两个 T 型钉稳定胰腺假性囊肿，并在内镜可视化下确认针吸。然后使用 LigaSure（Valleylab，Boulder，CO）切开假性囊肿。使用 Endopath ETS-Flex 关节线性吻合器/切割器（Ethicon Endo-Surgery，Inc.，Cincinnati，OH）完成囊肿胃吻合术。手术时间不到 2 小时，且无需切口。根据人类研究保护计划的政策，对单个病例的审查不属于人类受试者研究的定义范围，不需要机构审查委员会的审查和批准。
患者术后恢复良好，胰腺假性囊肿大小在 2 周内显著缩小至 3.5 厘米。
通过现有的经皮胃造口瘘进行混合 NOTES 囊肿胃造口术是微创引流胰腺假性囊肿的极佳方法。
