Laboratory Animal Center, Department of Surgery, Chang Gung Memorial Hospital, Linko, Chang Gung University, Taoyuan, Taiwan.
J Thorac Cardiovasc Surg. 2011 May;141(5):1223-30. doi: 10.1016/j.jtcvs.2010.11.011. Epub 2011 Feb 1.
The present study aimed to evaluate the performance of transtracheal thoracic exploration and pericardial window creation in a canine survival model.
Transthoracic exploration was performed in 14 dogs. Under general anesthesia, after an incision in the right lateral wall of the middle-lower portion of the trachea was made, a 9-mm metal tube was advanced into the thoracic cavity. For thoracic cavity exploration and pericardial window creation, a flexible bronchoscope was introduced through the metal tube into the thoracic cavity. After thoracoscopy, a Dumon stent (Novatech, Grasse, France) was used to cover the tracheal incision site and facilitate healing. Animals were evaluated by endoscopy 1 and 2 weeks later. Animals were humanely killed, and necropsy was performed 2 weeks after the transtracheal natural orifice transluminal endoscopic surgery.
Fourteen dogs underwent transtracheal thoracic exploration lasting for an average of 110 minutes (range, 80-150), with 3 perioperative deaths. At 2 weeks after pericardial window creation, endoscopy revealed normal healing of the tracheal incision sites in all 11 surviving animals. Necropsy on the 11 animals at 2 weeks showed 9 adhesions around the pericardial window and 5 adhesions around the tracheal incision region. No mediastinitis or abscesses could be identified.
Transtracheal thoracic exploration is technically feasible. Increasing surgical experience together with improvement in endoscopic techniques will further facilitate the development of natural orifice transluminal endoscopic surgery for thoracic diseases.
本研究旨在评估经气管透壁性胸部探查和心包开窗术在犬生存模型中的性能。
对 14 只狗进行经胸探查。在全身麻醉下，于气管中下段右侧壁切开后，将 9mm 金属管推进胸腔。为了进行胸腔探查和心包开窗，将柔性支气管镜通过金属管引入胸腔。胸腔镜检查后，使用 Dumon 支架（法国 Grasse 的 Novatech）覆盖气管切口部位，促进愈合。术后 1 周和 2 周通过内镜进行评估。动物在 2 周后进行人道处死，并进行尸检。
14 只狗进行了平均持续 110 分钟（80-150 分钟）的经气管透壁性胸部探查，3 只在围手术期死亡。心包开窗术后 2 周，11 只存活动物的内镜检查均显示气管切口部位正常愈合。11 只动物在 2 周时进行尸检，发现心包窗周围有 9 处粘连，气管切口区域有 5 处粘连。未发现纵隔炎或脓肿。
经气管透壁性胸部探查在技术上是可行的。随着手术经验的增加和内镜技术的改进，将进一步促进经自然腔道内镜手术治疗胸腔疾病的发展。
