支架置入术为胸腔镜NOTES（经自然腔道内镜手术）提供了安全的食管闭合。
Stent placement provides safe esophageal closure in thoracic NOTES(TM) procedures.
机构信息
Massachusetts General Hospital, Boston, MA 02114, USA.
出版信息
Surg Endosc. 2011 Mar;25(3):913-8. doi: 10.1007/s00464-010-1297-2. Epub 2010 Sep 4.
BACKGROUND
Safe esophageal closure remains a challenge in transesophageal Natural Orifice Transluminal Endoscopic Surgery (NOTES). Previously described methods, such as suturing devices, clips, or submucosal tunneling, all have weaknesses. In this survival animal series, we demonstrate safe esophageal closure with a prototype retrievable, antimigration stent.
METHODS
Nine Yorkshire swine underwent thoracic NOTES procedures. A double-channel gastroscope equipped with a mucosectomy device was used to create an esophageal mucosal defect. A 5-cm submucosal tunnel was created and the muscular esophageal wall was incised with a needle-knife. Mediastinoscopy and thoracoscopy were performed in all swine; lymphadenectomy was performed in seven swine. A prototype small intestinal submucosal (SurgiSIS(®)) covered stent was deployed over the mucosectomy site and tunnel. Three versions of the prototype stent were developed. Prenecropsy endoscopy confirmed stent location and permitted stent retrieval. Explanted esophagi were sent to pathology.
RESULTS
Esophageal stenting was successful in all animals. Stent placement took 15.8 ± 4.8 minuted and no stent migration occurred. Prenecropsy endoscopy revealed proximal ingrowth of esophageal mucosa and erosion with Stent A. Mucosal inflammation and erosion was observed proximally with Stent B. No esophageal erosion or pressure damage from proximal radial forces was seen with Stent C. On necropsy, swine 5 had a 0.5-cm periesophageal abscess. Histology revealed a localized inflammatory lesion at the esophageal exit site in swine 1, 3, and 9. The mucosectomy site was partially healed in three swine and poorly healed in six. All swine thrived clinically, except for a brief period of mild lethargy in swine 9 who improved with short-term antibiotic therapy. The submucosal tunnels were completely healed and no esophageal bleeding or stricture formation was observed. All swine survived 13.8 ± 0.4 days and gained weight in the postoperative period.
CONCLUSIONS
Esophageal stenting provides safe closure for NOTES thoracic procedures but may impede healing of the mucosectomy site.
背景
经食管自然腔道内镜外科手术（NOTES）中安全的食管闭合仍然是一个挑战。以前描述的方法，如缝合装置、夹子或黏膜下隧道，都有其弱点。在这项生存动物系列研究中，我们展示了使用可回收、抗迁移支架进行安全的食管闭合。
方法
9 头约克夏猪接受了胸腔 NOTES 手术。使用配备黏膜切除术装置的双通道胃镜创建食管黏膜缺损。创建 5cm 黏膜下隧道并用针刀切开食管肌层。所有猪均进行了纵隔镜检查和胸腔镜检查；7 头猪进行了淋巴结切除术。在黏膜切除部位和隧道上部署了一个原型小肠黏膜下（SurgiSIS®）覆盖支架。开发了三种原型支架版本。术前内镜检查确认了支架位置并允许取出支架。取出的食管被送到病理科。
结果
所有动物的食管支架放置均成功。支架放置耗时 15.8±4.8 分钟，无支架迁移。术前内镜检查显示支架 A 近端食管黏膜向内生长和侵蚀。支架 B 近端观察到黏膜炎症和侵蚀。支架 C 未见近端径向力引起的食管侵蚀或压力损伤。尸检时，猪 5 有 0.5cm 食管旁脓肿。组织学检查显示猪 1、3 和 9 的食管出口处有局部炎症病变。3 头猪的黏膜切除术部位部分愈合，6 头猪愈合不良。除了猪 9 在接受短期抗生素治疗后短暂出现轻度昏睡并有所改善外，所有猪的临床状况均良好。黏膜下隧道完全愈合，未见食管出血或狭窄形成。所有猪均存活 13.8±0.4 天，并在术后期间体重增加。
结论
食管支架为 NOTES 胸部手术提供了安全的闭合，但可能会阻碍黏膜切除术部位的愈合。
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