Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
Surg Endosc. 2012 Aug;26(8):2322-30. doi: 10.1007/s00464-012-2183-x. Epub 2012 Feb 23.
A highly reliable and safe means of gastric closure for natural orifice transluminal endoscopic surgery (NOTES) has yet to be developed. The authors have previously described the self-approximating transluminal access technique (STAT) as a means for gastrotomy closure in transgastric surgery. It has yet to be determined whether biologic mesh can be utilized in facilitating gastrotomy closure via STAT. The aim of this study was to determine the feasibility of implanting an acellular porcine dermal matrix (LifeCell) into the STAT tunnel and investigate whether it will become incorporated into the submucosal plane of the STAT tunnel.
Five pigs underwent transgastric left uterine horn resection utilizing STAT. For closure, the acellular porcine dermal matrix was implanted within the submucosal plane, occluding the seromuscular incision. The mucosal incision was then closed over the matrix with endoscopically placed clips. Necropsy was performed after a 3 week survival period. Histopathological evaluation of the tunnel and matrix was performed.
The matrix was successfully implanted in all five animals. Average OR time was 151 ± 68 min. Average time to anchor and embed the matrix within the tunnel was 4 ± 1 and 9 ± 12 min, respectively. There was one duodenal perforation related to a balloon occlusion device. Postoperative course was unremarkable; the average weight gain at 3 weeks was 22 ± 5 lbs. On necropsy, one animal had some protrusion of the matrix at the serotomy, with adhesions to small bowel and liver. Histopathology revealed one clinically insignificant microabscess but otherwise demonstrated local inflammation and fibrovascular ingrowth into the matrix.
The porcine dermal matrix can be successfully implanted within the gastric submucosal plane and evidence of incorporation into the gastric wall by 3 weeks was demonstrated.
目前还没有开发出一种用于经自然腔道内镜外科手术（NOTES）的高度可靠且安全的胃闭合方法。作者之前曾描述过自逼近经腔道进入技术（STAT），作为经胃手术中胃切开术闭合的一种方法。尚未确定生物网是否可用于通过 STAT 促进胃切开术闭合。本研究旨在确定将脱细胞猪真皮基质（LifeCell）植入 STAT 隧道中的可行性，并研究其是否会被纳入 STAT 隧道的黏膜下层。
5 只猪接受了经胃左子宫角切除术，采用 STAT。为了闭合，将脱细胞猪真皮基质植入黏膜下层，封闭浆肌层切口。然后用内镜放置的夹将黏膜切口夹闭在基质上。在 3 周的存活期后进行尸检。对隧道和基质进行组织病理学评估。
基质在所有 5 只动物中均成功植入。平均手术时间为 151±68 分钟。平均时间将基质锚定并嵌入隧道分别为 4±1 和 9±12 分钟。有 1 例与球囊阻塞装置相关的十二指肠穿孔。术后过程无异常；3 周时的平均体重增加为 22±5 磅。尸检时，1 只动物的浆膜切开处有基质轻微突出，与小肠和肝脏粘连。组织病理学检查显示有 1 个临床意义不大的微脓肿，但其他部位显示局部炎症和纤维血管向内生长进入基质。
猪真皮基质可以成功地植入胃黏膜下层，并且在 3 周时显示出整合到胃壁的证据。
