Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, WACC 460, Boston, MA 02114, USA.
Surg Endosc. 2010 Aug;24(8):2022-30. doi: 10.1007/s00464-010-0898-0. Epub 2010 Feb 21.
The feasibility of transanal rectosigmoid resection with transanal endoscopic microsurgery (TEM) was previously demonstrated in a swine nonsurvival model in which transgastric endoscopic assistance also was shown to extend the length of colon mobilized transanally.
A 2-week survival study evaluating transanal endoscopic rectosigmoid resection with stapled colorectal anastomosis was conducted with swine using the transanal approach alone (TEM group, n = 10) or a transanal approach combined with transgastric endoscopic assistance (TEM + TG group, n = 10). Gastrotomies were created using a needleknife and balloon dilation, then closed using prototype T-tags. Outcomes were evaluated and compared between the groups using Student's t-test and Fisher's exact test.
Relative to the TEM group, the average length of rectosigmoid mobilized in the TEM + TG group was 15.6 versus 10.5 cm (p < 0.0005), the length of the resected specimen was 9 versus 6.2 cm (p < 0.0005), and the mean operative time was 254.5 versus 97.5 min (p < 0.0005). Intraoperatively, no organ injury or major bleeding was noted. Two T-tag misfires occurred during gastrotomy closure and four small staple line defects requiring transanal repair including one in the TEM group and three in the TEM + TG group (p = 0.2). Postoperatively, there was no mortality, and the animals gained an average of 3.4 lb. Two major complications (10%) were identified at necropsy in the TEM + TG group including an intraabdominal abscess and an abdominal wall hematoma related to T-tag misfire. Gastrotomy closure sites and colorectal anastomoses were all grossly healed, with adhesions noted in 60 and 70% and microabscesses in 50 and 20% of the gastrotomy sites and colorectal anastomoses, respectively.
Natural orifice translumenal endoscopic surgery (NOTES) for rectosigmoid resection using TEM with or without transgastric endoscopic assistance is feasible and associated with low morbidity in a porcine survival model. Transgastric assistance significantly prolongs the operative time but extends the length of the rectosigmoid mobilized transanally, with a nonsignificant increase in complication rates related to gastrotomy creation.
经肛门内镜微创手术（TEM）经肛门直肠乙状结肠切除术的可行性先前在猪非存活模型中得到了证明，其中经胃内镜辅助也被证明可延长经肛门游离的结肠长度。
使用经肛门入路单独（TEM 组，n = 10）或经肛门入路联合经胃内镜辅助（TEM + TG 组，n = 10）进行了一项为期 2 周的猪经肛门内镜直肠乙状结肠切除术吻合术的存活研究。使用针刀和球囊扩张创建胃造口，然后使用原型 T 标签关闭。使用学生 t 检验和 Fisher 精确检验比较两组之间的结果。
与 TEM 组相比，TEM + TG 组直肠乙状结肠的平均游离长度为 15.6 厘米对 10.5 厘米（p <0.0005），切除标本的长度为 9 厘米对 6.2 厘米（p <0.0005），平均手术时间为 254.5 分钟对 97.5 分钟（p <0.0005）。术中未发现器官损伤或大出血。胃造口关闭时发生两次 T 标签故障，四次小吻合口缺陷需要经肛门修复，其中 TEM 组 1 例，TEM + TG 组 3 例（p = 0.2）。术后无死亡，动物平均增重 3.4 磅。TEM + TG 组在解剖时发现 2 种主要并发症（10%），包括腹腔脓肿和 T 标签故障引起的腹壁血肿。胃造口和直肠乙状结肠吻合口均大体愈合，60%和 70%的胃造口处和直肠乙状结肠吻合口有粘连，50%和 20%的胃造口处和直肠乙状结肠吻合口有微脓肿。
使用 TEM 经自然腔道内镜外科（NOTES）进行直肠乙状结肠切除术具有可行性，且在猪存活模型中具有低发病率。经胃内镜辅助虽然显著延长了手术时间，但可延长经肛门游离的直肠乙状结肠长度，与胃造口术相关的并发症发生率无显著增加。
