首例“经口”阑尾切除术患者恢复良好

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Appendix Removed via Patient's Mouth

Surgery Is First in U.S.; Patient Recovering Smoothly

March 19, 2008 -- Last week Jeff Scholz of San Diego became the first person in the U.S. to have his appendix removed through his mouth.

Other than what he describes as a very mild sore throat, the 40-year-old former Marine says he felt very little pain after the surgery and was back to normal within a few days.

\"They told me to take it easy, but I feel great,\" he told WebMD Tuesday afternoon -- six days after having his diseased appendix removed in a procedure known as Natural Orifice Transluminal Endoscopic Surgery (NOTES).

\"Two days ago I started to do sit-ups again, and I ended up working a 10-hour day yesterday.\"

Appendectomy via Mouth

Surgeons at the University of California San Diego's Center for the Future of Surgery performed the highly experimental operation, which involved guiding surgical instruments through the mouth, down the esophagus, and into the stomach with a tube-like device known as a flexible endoscope.

Once inside the stomach, a small incision was made into the stomach wall to allow access to the appendix.

These days most appendectomies are performed laparoscopically, which is much less invasive than traditional surgery but still requires cuts through the abdomen wall.

The NOTES procedure is even less invasive than laparoscopic appendectomy, lead surgeon Santiago Horgan, MD, said in a news statement.

\"Only one small incision to insert a small camera in the belly button was required to complete the surgery vs. three incisions required for a laparoscopic procedure,\" he says.

Scholz's surgery went off without a hitch, and the University of California, San Diego (UCSD) surgical team hopes to perform one more appendectomy through the mouth soon.

Safety Concerns Remain

If all goes well, the two initial surgeries will be followed by a pilot study of the procedure, UCSD department of surgery chairman Mark A. Talamini, MD, tells WebMD.

Talamini is also president elect of the Society of American Gastrointestinal and Endoscopic Surgeons.

\"These are the first baby steps to look at this type of surgery to see if it is feasible, and to see if it is a potentially better way to approach appendix removal,\" he says.

The procedure has also been used to remove diseased gallbladders, with endoscopes inserted through the mouth or the vagina.

\"The paradigm shift here may be that the stomach or vagina may heal better than the skin and [connective tissue] do,\" Talamini says. \"We aren't ready to say that this is the case, but it is worth investigating.\"

The concern about going through the wall of the stomach is that stomach juices could leak out if the hole is not properly closed, exposing the patient to potentially life-threatening complication.

Because of this potential risk, researchers are proceeding with extreme caution, Talamini says.

\"We are working to develop the technique and the tools to do this procedure in the most foolproof way possible,\" he says.

http://www.webmd.com/news/200803 ... -via-patients-mouth

就在上周，圣地亚哥的Jeff Scholz做了一回“第一个吃螃蟹的人”——外科医生经口切除了他的阑尾，这种手术方式在美国还是首例。（March 19, 2008）

这位40岁的前海军陆战队队员术后只觉得有一点轻微的喉咙痛，除此之外几乎没有太多的疼痛感，并且在术后几天就完全康复了。而就在六天之前他刚刚接受了经口阑尾切除术，这种手术被称为经自然腔道手术（NOTES)。术后四天他又开始做仰卧起坐，而在术后5天连续工作了10个小时。

经口阑尾切除术
加州大学圣地亚哥中心的外科医生为未来无手术刀的外科手术进行了一个实验性操作，具体包括引导手术器械经口穿过食道，进入胃部，这个器械是一种管样装置即一个能灵活转向的内窥镜。

进入胃之后，医生在胃壁上作了一个小切口，通过这个口可以到达阑尾。

最近几年，多数的阑尾切除术都是通过腹腔镜来完成，这种手术方式与传统的开腹手术相比创伤小很多，但是依然要在腹部开几个小口来进行操作。而NOTES甚至比腹腔镜阑尾切除术创伤更小， 只需要在肚脐处开个小口插入一个小小的摄像头就可以完成手术，而腹腔镜手术则是要在腹部开三个口。Scholz的手术进行地很顺利，加州大学圣地亚哥中心的外科手术小组希望能再做一例。

仍有手术是否安全的顾虑

如果一切进展顺利，这两次手术之后将在医院进行一个试点研究——NOTES对于阑尾切除来说是否是一种更好的手术方式。这种类型的操作还可以经口或阴道插入内窥镜来切除坏死的胆囊。

这种手术的成功可能是因为胃或阴道的愈合优于皮肤和结缔组织，但这种术式还需要进一步探讨。研究者将严密观察患者胃壁上的伤口是否愈合，如果小洞没有完全封闭，胃液则可能漏到腹腔中，这时患者将可能出现威胁到生命的并发症。

由于有这种潜在的危险，研究人员在整个过程中都极为谨慎， 研究者正努力改进操作技术和手术器械以确保安全。