The Animal Experiment Of Without Mucosal Closure Transgastric Natural Orifice Transluminal Endoscopic Surgery

With the rapid development of social progress and development of endoscopic techniques,natural orifice transluminal endoscopic surgery(Natural Orifice Transluminal Endoscopic Surgery,NOTES)since its inception in 2004,the application prospect of its innovative design concept and a potential alternative to traditional surgery,laparoscopic surgery,laparoscopic surgery has attracted great interest of physicians and Surgeons of digestive endoscopy at present,become one of the focus of the development of minimally invasive.Due to the development of digestive endoscopy,surgery is the target area by intraperitoneal NOTES surgery,compared with vaginal incision,anal colorectal approach,transurethral approach approach,transgastric natural orifice transluminal endoscopic surgery(Transgastric Natural Orifice Transluminal Endoscopic Surgery,TG-NOTES)has more advantages and more research and concern,one of the most striking is the closure of mucosal stripping technique of endoscopic mucosal incision(Endoscopic Submucosal Dissection Without Mucosal Closure,ESDWMC)of transgastric natural orifice transluminal endoscopic surgery.But don’t close gastric mucosal incision by natural orifice transluminal endoscopic surgery(Without Mucosal Closure Transgastric Natural Orifice Transluminal Endoscopic Surgery With Endoscopic Submucosal Dissection,WTG-NOTES)can solve the natural cavity incision closure and bacterial infection and other two major problems,is the key of WTG-NOTES technology can replace the traditional surgery or laparoscopic surgery in clinic.The purpose of this study is to through animal experiments,the feasibility and safety evaluation of WTG-NOTES technology,according to the principle of surgical asepsis assessment of WTG-NOTES infection prevention method,compared with traditional laparoscopic surgery perioperative implications of experimental animal wound stress index,impact assessment of WTG-NOTES on trauma stress,for the clinical application of WTG-NOTES in theory,mentioned on the basis of practice and experience.Methods: select local sow weight 35 kg of the experimental animal of general anesthesia,abdominal exploration by using WTG-NOTES technology and traditional laparoscopic surgery,anesthesia immediately after feeding liquid food,normal dietrecovery after second days.The research consists of three parts,a selection of 8 local experimental sows,first using WTG-NOTES technology for abdominal exploration,record the complications of surgery,exploration at the end was changed to the traditional laparoscopic abdominal exploration,observation of serosa cut WTG-NOTES caused by technology export,pneumoperitoneum pressure numerical observation records,numerical tests after inflation the pressure of pneumoperitoneum,observed after filling test serosa incision without liquid overflow;experiment two,selection of 16 local sows were randomly divided into experimental group and control group,8 rats in each animal,the experimental group immediately after anesthesia intravenous antibiotics,postoperative 48 hours after anesthesia combined with intravenous antibiotics,application saline,iodine disinfectant and antibiotic clean experimental animal’s face,mouth,esophagus and stomach cavity,the control group intravenous anti Antibiotics,two groups of animal are used WTG-NOTES technology for abdominal exploration,extraction of preoperative and postoperative gastric fluid,peritoneal fluid,immediately sent for bacterial culture,bacterial colonies were observed and recorded,strain identification;experiment three,with only 16 local sows were randomly divided into experimental group and control group,8 rats in each group in the second experiment animal,experimental group for infection prevention and control,a group with WTG-NOTES underwent abdominal exploration(endoscopic group),a group with traditional laparoscopic abdominal exploration(laparoscopic group),respectively before anesthesia induction,the end of the surgery after surgery,24 hours,48 hours after the end of operation,operation after 72 hours,7days after the end of surgery of venous blood,detection of white blood cell(WBC),cortisol(CORT),C-reactive protein(CRP),tumor necrosis factor alpha(TNF-alpha),comparison of trauma Stress index.Results: experiment one: 8 local pigs were successfully through the WTG-NOTES technology to complete abdominal exploration,no serious complications of laparoscopic exploration found no activity of serosa incision bleeding,air pneumoperitoneum pressure more than before after the experiment,0.8± 1.1mm Hg,the difference was not statistically significant(P > 0.05),filled with water after the experiment was not found leakage;experiment two: experimental group and control group before gastric bacterial colony count comparison(28300±17000CFU/ml VS 25600 ± 19100CFU/ml),there was no statistically significant difference(P > 0.05),identification of strains with Escherichia coli,Klebsiella pneumoniae,experimental group postoperative gastric and peritoneal lavage fluid was not cultivated bacteria,4 animal in the control group(50%)postoperative gastric bacteria,and preoperative gastric fluid bacterial colony number comparison(14500 +11800CFU/ml VS 25600 + 19100CFU/ml),there are differences Statistical significance(P<0.05),compared with the experimental group(4/8 VS 0/8),the difference was statistically significant(P<0.05),the control group had 1 animal(12.5%)peritoneal fluid culture bacteria,compared with the experimental group,the difference was not statistically significant(P > 0.05);experiment three: In the six test time points,compared two groups of experimental animal CRP,TNF-alpha content,there was no statistically significant difference(P > 0.05),WBC in the 24 hours after operation and at the age of 72 hours,the NOTES group was significantly higher than that in the laparoscopic group(15.36±2.62 vs 13.2±2.73,18.84±6.41 vs16.80 ± 5.02),and the difference was statistically significant(P<0.05).CORT was significantly higher in the NOTES group than that in the laparoscopic group at the end of operation(29.72 ± 10.3 vs 21.74 ± 8.7),and the difference was significant(P<0.05).The rest of the detection time,WBC and CORT of the two groups of experimental animals,the difference was not statistically significant(P > 0.05)..Conclusion: 1,Without mucosal closure transgastric natural orifice transluminal endoscopic surgery with endoscopic submucosal dissection(WTG-NOTES)in a short time to shut down caused by natural orifice surgery incision and tunnel,safe and feasible;2 WTG-NOTES by intravenous antibiotics combined with local disinfection is effective,effective way to reduce the infection of WTG-NOTES,according to the need of surgical aseptic the principle of operation,preparing for gastrointestinal surgery and preoperative surgical aseptic operation,infection prevention and control;3,compared with laparoscopic surgery,WTG-NOTES does not increase in confining the experimental animal trauma surgery stress factor content,increase of the experimental animal traumatic stress.Although NOTES is a new technology,it is worth further study,although the current development is limited.