Role Of Digestive Endoscopy In The Diagnosis And Treatment For Penetrating Abdominal Trauma

Objective To explore the role of digestive endoscopy in the diagnosis and treatment for penetrating abdominal trauma in an abdominal knife stabbed animal model.Methods Eighteen beagles were randomly divided into endoscopic treatment group(n=9)and conventional treatment group(n=9).Under the guidance of E-NOTES,the modeler stabbed the dagger with size mark into the abdomen,and made the models of simple bleeding,simple perforation and bleeding combined with perforation with similar size and type of trauma.each case had only one trauma.The therapists gave first aid to the injured animals.In the endoscopic treatment group,a wound occluder was placed on the body surface to seal the wound,while in the conventional treatment group,abdominal bandages were used to stop bleeding.After 10 minutes,the endoscopic treatment group was treated by endoscopy through the wound occluder into the abdomen,and the conventional treatment group was treated by laparotomy.In the experiment,the changes of vital signs,the effect and time of abdominal wound treatment,the field of vision and exploration of celiac exploration,the time of entering the abdominal cavity,the time of finding the lesion,the time of celiac exploration,the time of treating the lesion,the total time of operation,the treatment effect and the detection of the lesion were compared between the two groups.Postoperative,the general conditions,food intake,water intake,time to return to normal food intake,response to external stimuli,hair color,weight change,and two-week survival were observed.After two weeks,the animals were euthanized and dissected to evaluate the therapeutic effect,abdominal infection,and complications of the two groups.Results The vital signs of the two groups were stable,and the difference was not statistically significant(P > 0.05).The time to seal and bandage the abdominal wounds for hemostasis was shorter in the endoscopic treatment group than in the conventional treatment group(0.85±0.07 min vs 1.89±0.22 min,P < 0.05).There was no significant difference in the incidence of bleeding after hemostasis between the endoscopic treatment group and the conventional treatment group(0% vs 22.22%,P > 0.05).Both groups were satisfied with the ability of intraoperative exploration.There was no significant difference between the endoscopic treatment group and the conventional treatment group in the quantitative score of the exploratory ability of hepatobiliary,diaphragm and omentum(2.72±0.36 vs 2.83±0.35,2.83±0.35 vs 3.00±0.00,3.00±0.00 vs 3.00±0.00,respectively,all P > 0.05).However,in the quantitative score of spleen,intestine and mesentery exploration ability,the endoscopic treatment group was lower than the conventional treatment group(1.28±0.36 vs 2.56±0.46,2.33±0.25 vs 2.94±0.17,respectively),and the difference was statistically significant(all P < 0.05).When the lesions were found,both groups could be treated successfully.In the operation time of each stage,the time of entering the abdominal cavity was shorter in the endoscopic treatment group than in the conventional treatment group(0.95 ± 0.09 min vs 1.43 ±0.25 min,P<0.05),while the time of celiac exploration,the time of treating the lesion,and the total time of operation were longer in the endoscopic treatment group than in the conventional treatment group(15.87±1.88 min vs 4.38±0.62 min,7.53±4.29 min vs5.01±0.78 min,32.93±5.67 min vs 19.18±1.26 min,respectively,all P < 0.05),but the time of finding the lesion was not significantly different between the endoscopic treatment group and the conventional treatment group(0.27±0.04 min vs 0.24±0.05 min,P>0.05).In the endoscopic treatment group,only one case of mesangial vascular injury was detected in the three models of intestinal perforation combined with mesangial vascular injury,while all lesions were detected in the conventional treatment group.However,the detection ability of the total lesions was not significantly different between the endoscopic treatment group and the conventional treatment group(77.78%vs 100%,P > 0.05).After surgery,except for one animal in the conventional treatment group who died of abdominal infection,the animals successfully diagnosed and treated in both groups were generally in good condition and responded well to external stimuli12 hours after surgery.In terms of normal food intake within 24 hours,the endoscopic treatment group was faster than the conventional treatment group(85.71% vs 11.11%,P< 0.05),and there was no significant difference in weight change between the endoscopic treatment group and the conventional treatment group at two weeks after surgery(0.27±0.30 kg vs 0.25±0.33 kg,P > 0.05).Two weeks after surgery,there was no significant difference in survival rate and infection rate between the endoscopic treatment group and the conventional treatment group(100% vs 88.89%,0% vs 11.11%,all P > 0.05).However,the incidence of abdominal adhesion after two weeks was lower in the endoscopic treatment group than in the conventional treatment group(28.57% vs87.50%,P < 0.05).Conclusions 1 This wound occluder can quickly and effectively close the wound and stop bleeding,and provide access for endoscopes and other instruments to enter the abdominal cavity.2 It is safe and feasible to diagnose,classify and treat penetrating abdominal trauma with digestive endoscopy,and it has the advantages of less trauma and faster recovery.