Elmunzer B Joseph, Chak Amitabh, Taylor Jason R, Trunzo Joseph A, Piraka Cyrus R, Schomisch Steve J, Rising Gail M, Elta Grace H, Scheiman James M, Ponsky Jeffrey L, Marks Jeffrey M, Kwon Richard S
Division of Gastroenterology, University of Michigan, Ann Arbor, MI 48109, USA.
Surg Innov. 2010 Jun;17(2):101-7. doi: 10.1177/1553350610365347.
Access sites other than the anterior gastric wall may provide improved ergonomics for natural orifice transluminal endoscopic surgery (NOTES). Endoscopic ultrasound (EUS) guidance significantly reduces, but does not eliminate, risk of access through these alternate sites. This study evaluates the utility of hydroperitoneum as an adjunct to EUS-guided access and closure of alternate access sites for NOTES.
Access and closure procedures were initially performed with EUS guidance alone, and subsequently, because of complications resulting from this technique, the procedures were performed with the aid of a transabdominal hydroperitoneum.
In this nonrandomized study, 6 access and closure procedures performed with EUS guidance alone resulted in 4 complications. After modifying the technique to incorporate pre-access hydroperitoneum, 7 EUS-guided access and closure procedures were performed without significant complications.
Hydroperitoneum appears to be an effective adjunct to ensure the safety of EUS-guided peritoneal entry and closure of alternate access sites for NOTES.
除胃前壁外的穿刺部位可能会改善经自然腔道内镜手术（NOTES）的人体工程学。内镜超声（EUS）引导可显著降低但不能消除通过这些替代部位穿刺的风险。本研究评估了水腹作为EUS引导穿刺及NOTES替代穿刺部位闭合辅助手段的效用。
穿刺及闭合操作最初仅在EUS引导下进行，随后，由于该技术引发并发症，操作在经腹水腹辅助下进行。
在这项非随机研究中，仅在EUS引导下进行的6次穿刺及闭合操作导致4例并发症。在将技术修改为纳入穿刺前水腹后，进行了7次EUS引导的穿刺及闭合操作，无明显并发症。
水腹似乎是确保EUS引导下经皮穿刺进入腹膜及NOTES替代穿刺部位闭合安全的有效辅助手段。
