NOTES新术式：经气管内镜甲状腺切除术动物实验探究.docVIP

NOTES新术式：经气管内镜甲状腺切除术动物实验探究 　 作者：牛军　刘恩宇　牛卫博　彭程　林鹏飞　王舟　 王加勇　赵传宗　贺兆斌　宋炜　徐克森　闫明　樊薇　寿楠海 【摘要】 目的：探讨一种全新的经自然腔道内镜手术（NOTES）——经气管内镜下甲状腺切除术的可行性、安全性和优越性。方法：采用3只巴马香猪和6只比格犬，利用自制带双通道的气管插管全身麻醉，置入内镜及器械，纵行切开甲状腺上方气管前壁软骨环。在内镜监视下行甲状腺部分或次全切除术。术毕连续或间断缝合气管前壁。结果：3只猪行经气管内镜下甲状腺部分切除术，6只狗行经气管内镜下甲状腺次全切除术，所有实验动物均顺利完成手术，无术中缺氧、窒息、气管梗阻及死亡。拔管后实验动物均自然苏醒，分别于2 、4 h后处死，观察气管切口缝合严密，无皮下气肿及血肿形成。结论：实验证实，经气管内镜甲状腺切除术是安全可行的。利用自然管腔（气管）作为甲状腺手术入路，保持了皮肤及颈前肌群的完整性，美观无疤痕，开拓了NOTES新领域。 【关键词】 NOTES·气管·内镜·甲状腺切除术·动物实验 　　【ABSTRACT】 Objective: To investigate the feasibility and safety of a new method of natural orifice transluminal endoscopic surgery(NOTES)-totally transtracheal endoscopic thyroidectomy (TTET). Methods：Three miniature swines and 6 beagle dogs were underwent TTET. Under general anesthesia, special designed endotracheal tube with 2-channel was used and endoscope and instruments were inserted through the respective channel. Incision of tracheal anterior wall was accomplished and partial or subtotal thyroidectomy was performed. Finally, the defects in the trachea were sutured with ENDO STITCH instrument. Results: Partial thyroidectomy was successfully accomplished on 3 pigs and subtotal thyroidectomy was done on 6 dogs. No serious complications such as anoxia, asphyxia, airway obstruction and death occurred during the operation. Animals were sacrificed 2h after the procedure and incision of trachea was found to be closely sutured. There were no subcutaneous emphysema and haematoma formation. Conclusion: Preliminary experimental results showed the feasibility and safety of TTET. Transtracheal access maintains the integrity of cervical tissues and achieves an optimal cosmetic outcome. TTET may open up a new field of NOTES on thyroid surgery. 　　【KEY WORDS】 NOTES·Trachea·Endoscope·Thyroidectomy·Experimental research 　　随着微创技术的进一步发展及人们美容需求的日益提高，甲状腺手术向着微创、无痛、无疤痕的方向发展。在不影响手术操作和治疗效果的前提下，为了得到更好的美容效果，外科医师进行了多种手术路径的尝试［1-2］。笔者经过3年研究，率先在国内临床成功开展了经自然腔道内镜手术（natural orifice transluminal endoscopic surgery，NOTES）［3］。基于对甲状腺解剖学及NO