Endoscopy Unit, Gastroenterology Department, ICMDiM, Hospital Clínic, University of Barcelona, IDIBAPS, CIBEREHD, Villarroel 170, 08026, Barcelona, Spain.
Surg Endosc. 2012 Feb;26(2):374-80. doi: 10.1007/s00464-011-1882-z. Epub 2011 Sep 5.
Inflammatory changes of different NOTES approaches remain unknown. The aim of this study was to compare the inflammatory effects of NOTES and laparoscopy.
Forty female pigs were assigned to transgastric, transrectal, and transvaginal NOTES and laparoscopic peritoneoscopy groups. Antiseptic technique was utilized for NOTES whereas laparoscopy was performed sterile. Intraperitoneal pressures were monitored and maintained below 15 mmH(2)O. Pneumoperitoneum was maintained with CO(2) in all groups. Pre- and postoperative blood samples of IL-6, Il-1β, and TNFα, and peritoneal fluid collected at surgery were analyzed. Animals were followed daily for 14 days. At necropsy, peritoneal fluid was collected for cytokine analysis.
Thirty-nine peritoneoscopies were successfully completed. The median procedure time was longer in the NOTES groups (57 min, range = 33-109) than in the laparoscopy group (33 min, range 32-36; P < 0.001); this was related to longer incision time and closure time. All 39 completed follow-up. Severe bleeding in the post-transrectal approach required early sacrifice of the remaining animal. Besides this, complications were similar among groups. At necropsy, adhesions were seen in four animals in the gastric group, five in the rectal group, two in the vaginal group, and two in the laparoscopic group (P = ns). There were no statistical differences in serum levels of TNFα among the groups. When serum TNFα values were expressed as the difference from the baseline, in the transvaginal group they were significantly lower than in the transrectal at 2 h [0.5 pg/ml (range = -14 to 59) vs. 60 pg/ml (range = -8 to 303); P = 0.041] and at 8 h [-5.5 pg/ml (range = -86 to 55] vs. 37 pg/ml (range = -30 to 62); P = 0.031]. The limitations of this study were that the analyses of IL-6 and Il-1β were not possible because most of the samples were below detectable levels, it was an animal model, and the sample size was small.
Inflammatory parameters are similar between NOTES and laparoscopic peritoneoscopy despite longer surgery time in the NOTES group. The vaginal route seems to reduce the inflammatory stress.
不同NOTES 方法的炎症变化尚不清楚。本研究旨在比较NOTES 和腹腔镜的炎症效应。
40 头雌性猪被分配到经胃、经直肠和经阴道 NOTES 和腹腔镜腹膜检查组。NOTES 采用消毒技术，而腹腔镜则采用无菌操作。监测并维持腹腔内压力低于 15mmHg（2）。所有组均用 CO（2）维持气腹。分析术前和术后 IL-6、Il-1β 和 TNFα 血样以及手术时采集的腹膜液。动物每天随访 14 天。尸检时，收集腹膜液进行细胞因子分析。
39 例腹膜检查成功完成。NOTES 组的中位手术时间（57 分钟，范围 33-109）长于腹腔镜组（33 分钟，范围 32-36；P<0.001）；这与较长的切口时间和闭合时间有关。所有 39 例均完成随访。经直肠入路后严重出血导致其余动物早期死亡。除此之外，各组并发症相似。尸检时，胃组有 4 只动物出现粘连，直肠组 5 只，阴道组 2 只，腹腔镜组 2 只（P=ns）。各组 TNFα 血清水平无统计学差异。当将血清 TNFα 值表示为与基线的差值时，阴道组在 2 小时时明显低于直肠组[0.5pg/ml（范围-14 至 59）比 60pg/ml（范围-8 至 303）；P=0.041]，8 小时时也明显低于直肠组[-5.5pg/ml（范围-86 至 55）比 37pg/ml（范围-30 至 62）；P=0.031]。本研究的局限性在于，由于大多数样本低于检测水平，因此无法进行 IL-6 和 Il-1β 的分析，这是一个动物模型，样本量较小。
尽管 NOTES 组的手术时间较长，但炎症参数在 NOTES 和腹腔镜腹膜检查之间相似。阴道入路似乎可以减轻炎症应激。
