目的：探索经自然腔道内镜手术（NOTES）切口入路的选择及初步尝试NOTES。方法以标准胃镜、肠镜为实验软式内镜，以3条中华田园犬为模型，分别经食道-胃、直肠、脐入路，行腹腔探查、肝活检、膀胱活检、胆囊切除术，比较各种入路的空间方位感、内镜自由度和图像感以判断内镜的操控性。结果3种入路相比较，经食道-胃、直肠入路，内镜的自由度和操控性优于经肚脐入路，腹腔探查术、肝活检术、膀胱活检术均顺利完成，胆囊切除术因暴露不佳，胆囊三角分离困难失败。结论上腹部自然腔道内镜手术入路选择直肠入路，下腹部自然腔道内镜手术入路选择胃-食道入路，可获得好的操控性。用标准胃肠镜做NOTES ，腹腔探查、组织活检等简单检查治疗均可顺利完成，但复杂手术仍需研发新设备，寻求新方法。%Objective The optimal access for natural orifice transluminal endoscopic surgery is still uncertain .This study was designed to compare the practicability and maneuverability of transgastric ,transunmbilical ,and transrectal approach in abdominal surgery in a canine model .Methods Three dogs were used in this research .Three approach :trangastric ,transunmbilical and tran-srectal approach were carried out for abdominal exploration ,liver biopsy ,bladder biopsy and an attempted cholecystectomy .The ma-neuverability ,endoscopic image ,performer′s perception ,and spatial orientation were evaluated .Results The maneuverability of trangastric ,and transrectal approach NOTES were better than transunmbilical NOTES .Abdominal exploration ,live biopsy ,and bladder biopsy were completed successfully .The cholecystectomy was failed because of poor exposure and difficulty of separating the around tissure .Conclusion The optimal approach for upper abdomen NOTES is transrectal route .For lower abdomen NOTES , the trangastric approach is superior to other accesses .Further study is needed to develop more flexible and precise equipment for NOTES and to evaluate more feasible access approach .
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