内镜经食管与胸腔镜纵隔淋巴结切除术：长期动物生存模型中的前瞻性随机试验。

Endoscopic transesophageal vs. thoracoscopic removal of mediastinal lymph nodes: a prospective randomized trial in a long term animal survival model.

机构信息

Interdisciplinary Endoscopy, Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany.

出版信息

Endoscopy. 2011 Dec;43(12):1090-6. doi: 10.1055/s-0030-1256768. Epub 2011 Oct 4.

DOI:10.1055/s-0030-1256768

PMID:21971927

Abstract

BACKGROUND AND STUDY AIMS

In cases where biopsies remain inconclusive, removal of mediastinal lymph nodes for further analysis requires surgical means. Natural orifice transluminal endoscopic surgery (NOTES) procedures allow incision/closure of the gut wall, which might enable endoscopic excision of pre-marked nodes. The aims of the current study were to investigate the feasibility, safety, and reproducibility of lymph node generation in an animal model to enable endoscopic ultrasound-guided (EUS) lymph node removal (ELR) using transesophageal NOTES access/closure and to compare this procedure with thoracoscopic lymph node removal (TLR) in a randomized long term survival animal study.

PATIENTS AND METHODS

Lymph node creation using graphite injection was performed in 12 pigs. After randomization into ELR and TLR groups, lymph nodes were marked with newly developed anchors under EUS guidance and removed using either ELR or TLR. ELR included incision of the esophageal wall and closure after lymph node removal. The main outcome measures were success in lymph node generation, technical success of lymph node removal, complications, and comparability of ELR and TLR.

RESULTS

Generation of lymph nodes proved successful in all animals in 46/48 sites injected (96 %). Anchors were placed through the selected nodes in a mean of 9.4 minutes. TLR and ELR were successful in all cases. One bleeding occurred during esophageal incision in ELR, which was stopped endoscopically. After lymph node removal, endoscopic suturing of the incision took a mean of 18 minutes. Procedure time was longer for ELR than TLR (mean 48 vs. 42 minutes). All animals survived the procedures. Autopsy after 4 weeks showed two thoracic wall abscesses in the TLR group and none in the ELR group. Microscopic analysis revealed well healed esophageal scars.

CONCLUSION

ELR proved to be feasible in this limited sample size and complications were not observed more frequently in this group than in the TLR group.

摘要

背景和研究目的

在活检结果仍不确定的情况下，为了进一步分析，需要通过手术切除纵隔淋巴结。经自然腔道内镜外科（NOTES）手术可以进行肠道壁的切开/闭合，这可能使内镜下切除标记好的淋巴结成为可能。本研究的目的是探讨在动物模型中生成淋巴结的可行性、安全性和可重复性，以便通过经食管NOTES 进入/闭合进行内镜超声引导下（EUS）的淋巴结切除（ELR），并在一项随机长期生存动物研究中比较该方法与胸腔镜淋巴结切除术（TLR）。

患者和方法

在 12 头猪中通过石墨注射进行淋巴结生成。随机分为 ELR 组和 TLR 组后，在 EUS 引导下用新开发的锚定器标记淋巴结，并采用 ELR 或 TLR 切除。ELR 包括食管壁切开和淋巴结切除后的闭合。主要观察指标为淋巴结生成成功、淋巴结切除技术成功、并发症以及 ELR 和 TLR 的可比性。

结果

在 48 个注射部位中的 46 个部位（96%）成功生成了淋巴结。锚定器平均在 9.4 分钟内穿过选定的淋巴结。TLR 和 ELR 在所有病例中均成功。ELR 中食管切开时有 1 例出血，内镜下止血成功。淋巴结切除后，内镜缝合切口平均需要 18 分钟。ELR 的手术时间长于 TLR（平均 48 分钟比 42 分钟）。所有动物均顺利完成手术。4 周后尸检显示 TLR 组有 2 例胸壁脓肿，而 ELR 组无脓肿。显微镜分析显示食管愈合良好的疤痕。