Potvin M, Gagner M, Pomp A
Department of Surgery, Hôtel-Dieu de Montréal, University of Montreal, Quebec, Canada.
Surg Endosc. 1996 Apr;10(4):400-2. doi: 10.1007/BF00191624.
Peptic ulcers are a frequent cause of upper G.I. bleeding. Since endoscopic methods may be unsuccessful, we have studied the feasibility of a new laparoscopic approach on a porcine model to control the bleeding of these ulcers with transgastric suturing.
After approval of the Animal Ethics Committee, 20 pigs (20 kg) were anticoagulated with intravenous sodium heparin (400 U/kg), and anesthetized. A nasogastric tube was inserted and a 15 mmHg pneumoperitoneum was created. Two 10-mm trocars and one 5-mm trocar were inserted through the abdominal cavity for laparoscopic guidance of three 7-mm endoluminal trocars inside the stomach through the anterior wall. Two posterior gastric ulcers were mechanically made on each pig by a "lift and cut technique." Ulcers were observed for at least 1 min for evidence of continued bleeding. First, bleeding ulcers were treated with sclerosing agents (epinephrine and ethanolmine oleate 5%); following sclerotherapy, ulcers were sutured intraluminaly with 2-0 silk, with intracorporeal knots.
Ulcers created extended into the vascular submucosa and averaged 7 mm in diameter. Bleeding rate was variable, but significant (2 cm3/min) in 40%. It was technically possible to suture these ulcers in 80%. Bleeding was controlled in 95% of cases with sclerotherapy and intraluminal sutures. One perforation of the posterior gastric wall occurred and four endoluminal trocars had to be reinserted after dislodgement.
It is possible to technically control bleeding ulcers in most cases with a laparoscopic transgastric technique using sclerosing agent and intraluminal sutures. This approach is promising for future human application; also, the intragastric suturing skills developed may be useful for other surgical interventions.
消化性溃疡是上消化道出血的常见原因。由于内镜治疗方法可能不成功，我们研究了一种新的腹腔镜方法在猪模型上通过经胃缝合控制这些溃疡出血的可行性。
经动物伦理委员会批准后，对20头体重20千克的猪静脉注射肝素钠（400 U/kg）进行抗凝，然后麻醉。插入鼻胃管并建立15 mmHg的气腹。通过腹腔插入两个10毫米套管针和一个5毫米套管针，用于腹腔镜引导三个7毫米腔内套管针经胃前壁进入胃内。通过“提起并切割技术”在每头猪身上机械制造两个胃后壁溃疡。观察溃疡至少1分钟，以确定是否持续出血。首先，用硬化剂（肾上腺素和5%油酸乙醇胺）治疗出血性溃疡；硬化治疗后，用2-0丝线在腔内缝合溃疡，并打体内结。
制造的溃疡延伸至血管黏膜下层，平均直径为7毫米。出血速率各不相同，但40%的出血速率显著（2立方厘米/分钟）。80%的情况下在技术上可以缝合这些溃疡。95%的病例通过硬化治疗和腔内缝合控制了出血。发生了1例胃后壁穿孔，4个腔内套管针移位后需要重新插入。
在大多数情况下，使用硬化剂和腔内缝合的腹腔镜经胃技术在技术上可以控制出血性溃疡。这种方法在未来应用于人类方面很有前景；此外，所开发的胃内缝合技术可能对其他外科手术干预有用。
