Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Videnska 1958, 140 21, Prague 4, Czech Republic.
Surg Endosc. 2013 Apr;27(4):1203-10. doi: 10.1007/s00464-012-2576-x. Epub 2012 Oct 17.
A safe technique is essential for successful access site closure in Natural Orifice Translumenal Endoscopic Surgery (NOTES) and for closures of iatrogenic perforations.
To compare an over-the-scope clip (OTSC) versus an endoloop + endoclips closure technique (KING closure).
40 minipigs underwent NOTES peritoneoscopy with liver biopsy. Gastrotomies and rectotomies were closed with OTSC (n = 20; 10× stomach, 10× rectum) or KING closure (n = 20; 10× stomach, 10× rectum). The animals were euthanized 28 days after the procedure. The main outcome variables were technical feasibility, effectiveness, and healing.
Stomach: All but one closure (KING) was successfully completed. The times of closure were similar between the techniques. At necropsy, all access sites were healed. In two animals (1× KING, 1× OTSC), an abscess, probably related to the closure technique, was found. Histologically, transmural healing with muscular bridging was observable in nine pigs for KING versus two pigs for OTSC closure (p = 0.003). Inflammation was present in three pigs for KING versus seven pigs for OTSC closure (p = 0.08). Rectum: All closures were successfully completed. The times of closure were similar between the techniques. At necropsy, all closure sites had healed. Transmural healing with muscular bridging was present in nine pigs for KING versus two pigs for OTSC closure (p = 0.003). Inflammation was present in two pigs for KING versus seven pigs for OTSC closure (p = 0.03). In one animal (OTSC), an enterocolic fistula developed in the proximity of the closure site.
OTSC and KING closure are comparable closure techniques in terms of technical feasibility and effectiveness. KING closure provides a superior histological outcome compared with OTSC closure.
经自然腔道内镜外科（NOTES）和医源性穿孔的入口部位关闭需要安全的技术，以确保成功。
比较一种内镜下用的全覆膜金属夹（OTSC）与一种内镜圈+夹闭（KING）闭合技术。
40 只小型猪进行 NOTES 腹膜腔检查和肝活检。胃造口和直肠造口用 OTSC（n = 20；10×胃，10×直肠）或 KING 闭合（n = 20；10×胃，10×直肠）关闭。术后 28 天处死动物。主要观察指标为技术可行性、有效性和愈合。
胃：除一个（KING）闭合失败外，其余均成功。两种技术的闭合时间相似。尸检时，所有入路部位均愈合。两例动物（1×KING，1×OTSC）发现脓肿，可能与闭合技术有关。组织学上，KING 闭合有 9 例可见全层愈合伴肌桥，而 OTSC 闭合有 2 例（p = 0.003）。KING 闭合有 3 例炎症，而 OTSC 闭合有 7 例（p = 0.08）。直肠：所有闭合均成功。两种技术的闭合时间相似。尸检时，所有闭合部位均愈合。KING 闭合有 9 例可见全层愈合伴肌桥，而 OTSC 闭合有 2 例（p = 0.003）。KING 闭合有 2 例炎症，而 OTSC 闭合有 7 例（p = 0.03）。一例动物（OTSC）在闭合部位附近发生肠结肠瘘。
OTSC 和 KING 闭合在技术可行性和有效性方面相似。与 OTSC 闭合相比，KING 闭合提供了更好的组织学结果。
