Dubcenco Elena, Grantcharov Teodor, Streutker Catherine J, Jiang Depeng, Baxter Nancy N, Baker Jeffrey P
St Michael's Hospital, Toronto, Ontario, Canada.
Surg Innov. 2011 Jun;18(2):106-13. doi: 10.1177/1553350610392065. Epub 2011 Jan 18.
Although adhesions can be removed by adhesiolysis using laparotomy or laparoscopy, they typically recur sometimes with equal severity. It is suggested that minimizing the invasiveness of the operative technique by using natural orifice translumenal endoscopic surgery (NOTES) may reduce adhesion re-formation. The aim of the study was to evaluate the feasibility and safety of adhesiolysis by using a novel transgastric NOTES approach and collect pilot data on adhesion recurrence after transgastric NOTES adhesiolysis.
One nonsurvival and 5 survival female pigs were used in this experimental survival study. Interventions included (a) induction of adhesions by laparotomy, (b) 2 weeks survival, (c) transgastric NOTES adhesiolysis with endoscopic evaluation and scoring of adhesions before and immediately after adhesiolysis, (d) 2 weeks survival, and (e) necropsy with endoscopic and necroscopic evaluation and scoring of recurrent adhesions. Main outcome measures were (a) survival and complication rates and (b) assessment of adhesion formation and re-formation using the Hopkins Adhesion Formation Score.
No mortality and no complications were observed. A total of 11 adhesions formed before the adhesiolysis in 5 survival study animals. All were successfully divided. The frequency of adhesions and median adhesion formation score decreased significantly immediately after adhesiolysis compared with that prior to the procedure (frequency, 11 vs 0, P = .011; the median score = 2.0 [range 1-3] vs 0.0 [range 0-0], P = .004). The treatment gains maintained at 2 weeks after the adhesiolysis.
The limitations of this study were the low number of study animals and short-term follow-up data.
Adhesiolysis using NOTES transgastric approach is feasible, safe, and effective with minimal adhesion re-formation.
尽管粘连可通过开腹或腹腔镜粘连松解术予以清除，但通常会复发，有时复发程度相同。有人提出，采用经自然腔道内镜手术（NOTES）尽量减少手术技术的侵入性，可能会减少粘连再形成。本研究的目的是评估采用一种新型经胃NOTES方法进行粘连松解术的可行性和安全性，并收集经胃NOTES粘连松解术后粘连复发的初步数据。
本实验性生存研究使用了1只非存活雌性猪和5只存活雌性猪。干预措施包括：（a）通过开腹手术诱导粘连；（b）存活2周；（c）经胃NOTES粘连松解术，并在内镜下评估粘连情况，在粘连松解术前和术后立即对粘连进行评分；（d）存活2周；（e）尸检，在内镜下和尸检时评估粘连复发情况并进行评分。主要观察指标为：（a）生存率和并发症发生率；（b）使用霍普金斯粘连形成评分评估粘连形成和再形成情况。
未观察到死亡和并发症。在5只存活研究动物中，粘连松解术前共形成11处粘连。所有粘连均成功分离。与手术前相比，粘连松解术后粘连频率和粘连形成评分中位数立即显著降低（频率，11处对0处，P = 0.011；中位数评分 = 2.0[范围1 - 3]对0.0[范围0 - 0]，P = 0.004）。粘连松解术后2周时治疗效果得以维持。
本研究的局限性在于研究动物数量较少且随访数据为短期。
采用经胃NOTES方法进行粘连松解术是可行、安全且有效的，粘连再形成最少。
