Hashiba Kiyoshi, Siqueira Pablo R, Brasil Horus A, D'Assunção Marco Aurélio, Moribe Daniel, Cassab Jorge Carim
Experimental Center and Endoscopic Unit, Hospital Sírio Libanês, São Paulo, SP, Brazil.
Arq Gastroenterol. 2011 Apr-Jun;48(2):159-62. doi: 10.1590/s0004-28032011000200013.
The endoscopic gastric perforation is a consequence of some endoscopic procedures and now a way to manage abdominal organs. This is the reason why endoscopists are studying a safe endoscopic repair.
To evaluate an endoscopic closure method for the gastric opening in natural orifice transenteric surgery
Short-term survival animal study.
Ten White Landrace pigs underwent a gastric perforation of 1.8 cm in diameter under general anesthesia. The opening was repaired with stitch assembled in a T-tag anchor placed through the gastric wall with a needle. A plastic transparent chamber, adapted to the endoscope tip protected the abdominal organs from the needle puncture outside the stomach. Six T-tags were placed in most cases and the stitches were tied with a metallic tie-knot, forming three sutures. The animals received liquids in the same operative day. One shoot antibiotic was used. The leakage test was performed with a forceps and by air distention.
No complication was detected in the postoperative course. One month later the endoscopy revealed a scar and some suture material was observed in all animals. The antral anterior gastric wall was clear with few adhesions in the laparotomy performed in the same time. The adhesions were intense in an animal in which a cholecystectomy was performed before the repair.
The endoscopic repair using T-tag and a protector chamber is feasible, easy to perform and safe. Further studies are needed to show the real value of this kind of procedure.
内镜下胃穿孔是某些内镜手术的后果，如今是一种处理腹部器官的方式。这就是内镜医师正在研究安全的内镜修复方法的原因。
评估经自然腔道内镜手术中胃开口的内镜闭合方法。
短期存活动物研究。
10只白色长白猪在全身麻醉下进行直径为1.8厘米的胃穿孔。通过用针将组装在T形标签锚中的缝线穿过胃壁来修复开口。一个适配于内镜尖端的塑料透明腔室可保护腹部器官免受胃外针刺。大多数情况下放置6个T形标签，并用金属结扎线系紧缝线，形成3针缝合。动物在手术当天接受液体。使用一剂抗生素。用镊子和空气扩张进行渗漏试验。
术后过程中未发现并发症。1个月后，内镜检查显示有瘢痕，所有动物均观察到一些缝线材料。同时进行的剖腹手术中，胃窦前壁清晰，粘连较少。在修复前进行过胆囊切除术的一只动物中粘连严重。
使用T形标签和保护腔室的内镜修复是可行的，易于操作且安全。需要进一步研究以表明这种手术的实际价值。
