Department of Thoracic Medicine, Chang Gung University, 5, Fushing Street, Gueishan Shiang, Taoyuan 333, Taiwan, ROC.
Surg Endosc. 2013 Jul;27(7):2428-35. doi: 10.1007/s00464-012-2753-y. Epub 2013 Jan 26.
Transoral endoscopic surgery has been shown to be feasible and safe in both humans and animal models. The purpose of this study was to evaluate the safety and efficacy of transoral and conventional thoracoscopy for thoracic exploration, surgical lung biopsy, and pericardial window creation.
The animals (n = 20) were randomly assigned to the transoral endoscopic approach group (n = 10) or conventional thoracoscopic approach group (n = 10). Transoral thoracoscopy was performed with a flexible bronchoscope via an incision over the vestibulum oris. In conventional thoracoscopy, access to the thoracic cavity was obtained through a thoracic incision. Surgical outcomes (body weight, operating time, operative complications, and time to resumption of normal diet), physiologic parameters (respiratory rate, body temperature), inflammatory parameters [white blood cell (WBC) counts and C-reactive protein (CRP)], and pulmonary parameters (arterial blood gases) were compared for both procedures.
The surgical lung biopsy and pericardial window creation were successfully performed in all animals except one animal in the transoral group. There was no significant difference in operating times between the groups. The increase in WBC in the transoral thoracoscopy group was significantly smaller on postoperative day 1 than in the conventional thoracoscopy group (p = 0.0029). The transoral group had an earlier return to preoperative body temperature (p = 0.041) and respiratory rate (p = 0.045) on day 7. With respect to pulmonary parameters, there was no significant difference in blood pH, pCO2, or PaCO2 between the transoral and transthoracic groups. All animals survived without complications 14 days after surgery.
This study demonstrated that the transoral approach was comparable to conventional thoracoscopic surgery for lung biopsy and pericardial window creation in terms of safety and efficacy.
经口内镜手术已在人体和动物模型中被证明是可行和安全的。本研究的目的是评估经口内镜和传统胸腔镜用于胸部探查、外科肺活检和心包窗创建的安全性和有效性。
将动物（n=20）随机分配到经口内镜组（n=10）或传统胸腔镜组（n=10）。经口胸腔镜检查通过在口前庭上的切口使用柔性支气管镜进行。在传统胸腔镜中，通过胸腔切口进入胸腔。比较两种方法的手术结果（体重、手术时间、手术并发症和恢复正常饮食的时间）、生理参数（呼吸频率、体温）、炎症参数[白细胞（WBC）计数和 C 反应蛋白（CRP）]和肺参数（动脉血气）。
除经口组的一只动物外，所有动物均成功进行了外科肺活检和心包窗创建。两组的手术时间无显著差异。经口胸腔镜组术后第 1 天 WBC 升高明显小于传统胸腔镜组（p=0.0029）。经口组第 7 天术前体温（p=0.041）和呼吸频率（p=0.045）恢复更快。关于肺参数，经口和经胸组之间的血液 pH、pCO2 或 PaCO2 无显著差异。所有动物在手术后 14 天均无并发症存活。
本研究表明，经口入路与传统胸腔镜手术在安全性和有效性方面相当，可用于肺活检和心包窗创建。
