本文選題：經(jīng)自然腔道手術(shù) + 腹腔探查　； 參考：《吉林大學(xué)》2012年碩士論文

【摘要】：背景：腹腔探查術(shù)是醫(yī)生用來探查腹腔疾病病因或明確病變程度而普遍采用的一種檢查和治療方法。許多外科醫(yī)生在臨床工作中都會偶爾遇到不明原因的腹痛，無法確定的診斷及可疑的腹腔內(nèi)腫塊，目前臨床開展的許多無創(chuàng)檢查。例如腹部B超、CT、MR等對于微小病變診斷效果差，僅能發(fā)現(xiàn)直徑5-10mm以上的腹腔內(nèi)腫物。且輔助檢查結(jié)果不能定性，僅起到提示作用，這樣容易造成小病變的漏診及誤診，例如對結(jié)核性腹膜炎、轉(zhuǎn)移到腹膜的腫瘤等常不能提示。而這些病人往往無特異性臨床表現(xiàn),行常規(guī)內(nèi)科檢查無法及時準確診斷病因,尤其是找不到原因的腹水患者，這不僅容易延誤病情也加重了病人經(jīng)濟負擔(dān)。在這種情況下，，腹腔探查作為一種非常有效,重要的手段常�？梢詭椭t(yī)生明確診斷。 腹腔探查的方式很對，其中開腹探查、腹腔鏡探查在技術(shù)上已經(jīng)非常成熟，而應(yīng)用NOTES技術(shù)行腹腔探查則是一種新興的腹腔探查方式。其在腹腔探查及靶向取活檢方面可顯示出其獨特的優(yōu)勢。本研究在總結(jié)前人經(jīng)驗基礎(chǔ)上，在現(xiàn)有的技術(shù)及條件下利用實驗豬模型對NOTES在腹腔探查及定向活檢方面的可行性及價值做出評價。 目的：腹腔探查及定向活檢是診斷腹部疾病非常有效地一種手段，傳統(tǒng)的方式對病人損傷大，費用高，病人難以接受。本研究只在評價NOTES在腹腔探查及取活檢中的可行性及應(yīng)用價值。 方法：對3只雌性家豬依據(jù)不同入路分組并做好術(shù)前準備。術(shù)中給予深度麻醉，監(jiān)護心電、血氧。術(shù)者分別從胃入路、腸入路、陰道入路建立切口，進入內(nèi)鏡，對擬定臟器行探查、取活檢并留取圖片。術(shù)后立即解剖，對各個臟器拍照。 結(jié)果：實驗動物經(jīng)過禁食及藥物處理胃腸道排空情況尚可。在擬定位置順利完成造口，未發(fā)生造口出血。不同入路造口耗費時間及操作難度不同。直腸及陰道入路操作相對容易，造口耗費時間最短；胃入路操作難度大，耗時最長。術(shù)后剖腹觀察未發(fā)現(xiàn)造口周圍臟器損傷。氣腹建立耗時約10分，完全滿足探查視野需要。經(jīng)胃入路對下腹部臟器如膀胱、卵巢、輸卵管觀察效果好。翻轉(zhuǎn)鏡身時可觀察到部分肝臟、胃、膽囊、脾臟及膈肌。經(jīng)腸及經(jīng)陰道入路的觀察范圍幾乎一致。對上腹部臟器如肝臟、膽囊、脾臟、胃、膈肌的觀察效果理想，可以看見全部，但是探查肝臟的膈肌面操作難度較大。對于下腹部臟器的探查需要翻轉(zhuǎn)鏡身，探查僅見部分膀胱，卵巢、輸卵管。三種入路對腹膜后臟器腎臟、輸尿管、胰腺探查均未成功；對大小腸、大網(wǎng)膜、壁層腹膜探查效果無明顯差別，均全部可見。對所見臟器均可順利進行靶向活檢，但同一臟器在不同入路下活檢術(shù)難度不同。 結(jié)論：NOTES在腹腔探查及靶向活檢方面具有巨大優(yōu)勢和潛力，不同入路之間對擬定臟器探查范圍存在差異，應(yīng)根據(jù)擬探查臟器選擇適宜的入路。
[Abstract]:Background: celiac exploration is a common method used by doctors to investigate the etiology or degree of celiac diseases. Many surgeons occasionally encounter unknown abdominal pain, uncertain diagnosis and suspected abdominal mass in their clinical work. For example, CT Mr of abdominal ultrasound is not effective in the diagnosis of minor lesions, and can only detect intraperitoneal masses larger than 5-10mm in diameter. And the results of auxiliary examination can not be qualitative, only play a role in prompting, so it is easy to cause small lesions of missed diagnosis and misdiagnosis, such as tuberculous peritonitis, metastasis to the peritoneal tumor and other often can not be prompted. But these patients often have no specific clinical manifestations, routine medical examination can not be timely and accurate diagnosis of the etiology, especially the ascites patients who can not find the cause, which is not only easy to delay the disease but also increase the economic burden of patients. In such cases, abdominal exploration is a very effective and important tool that often helps doctors to make a diagnosis. The technique of laparoscopy and laparoscopy is very mature, and the application of NOTES is a new way of abdominal exploration. It can show its unique advantages in abdominal exploration and targeted biopsy. On the basis of summarizing the previous experiences, the feasibility and value of NOTES in abdominal cavity exploration and directed biopsy were evaluated by using experimental pig model under the existing technology and conditions. Objective: abdominal exploration and directed biopsy are very effective methods for the diagnosis of abdominal diseases. The purpose of this study was to evaluate the feasibility and value of NOTES in abdominal cavity exploration and biopsy. Methods: three female pigs were divided according to different approaches and prepared for operation. Deep anesthesia, monitoring of ECG and blood oxygen were given during the operation. Incision was established from gastric approach, intestinal approach, vagina approach, and endoscopy, and the viscera was explored, biopsies were taken and pictures were taken. All organs were dissected immediately after operation. Results: the gastrointestinal emptying of experimental animals after fasting and drug treatment was good. The anastomosis was completed successfully in the proposed position, and no bleeding occurred. The time and difficulty of operation are different in different ways. The operation of rectal and vaginal approach is relatively easy, and the operation time is the shortest; the gastric approach is difficult and time-consuming. No visceral injury around the orifice was found in postoperative laparotomy. The establishment of pneumoperitoneum takes about 10 years and completely meets the needs of exploratory visual field. The effect of transgastric approach on lower abdominal organs such as bladder, ovary and fallopian tube is good. Part of the liver, stomach, gallbladder, spleen and diaphragm can be observed when turning the mirror body. The observed range of transintestinal and transvaginal approaches was almost the same. The observation of upper abdominal organs such as liver, gallbladder, spleen, stomach and diaphragm is ideal and can be seen completely, but the operation of exploring the diaphragm surface of liver is difficult. For the exploration of the lower abdomen viscera, only part of the bladder, ovary, fallopian tube should be turned over. The three approaches were not successful in the exploration of retroperitoneal organs, kidneys, ureters and pancreas, but there was no significant difference in the results of exploration of large intestine, omentum and parietal peritoneum, all of which could be seen. All the viscera were successfully performed targeted biopsy, but the same organ had different difficulty under different approaches. ConclusionWhile notes has great advantages and potential in abdominal cavity exploration and targeted biopsy, there are differences in the range of visceral exploration between different approaches, and the appropriate approach should be selected according to the intended exploration.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R656;R-332

【二級參考文獻】

相關(guān)期刊論文 前2條

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本文編號：1845020