摘要
目的评价经直肠自然腔道内镜手术（NOTES）辅助腹腔镜下肾切除术猪动物模型的应用价值。方法健康雌性普通猪6只，质量42～48kg，中位质量46kg。行经直肠NOTES辅助腹腔镜下肾切除术，左侧3例，右侧3例。全麻。取70。侧卧位，双后肢外展固定。于脐两侧缘分别置入5mm和10mm套管，距齿状线上方约2cm处置入5mm套管。自直肠套管置入腹腔镜，脐缘两套管置入操作器械。用电凝钩和吸引器锐性和钝性结合行肾脏游离，逐步显露肾蒂，用Hem—o—lok或钛夹阻断肾动、静脉及输尿管，完整切除肾脏，装入自制标本袋，扩大直肠切口后取出。结果本组6例手术均成功完成，未中转普通腹腔镜或开放手术，未新增操作通道。手术时间90～180rain，中位时间120min；术中失血量20～50ml，中位失血量40ml。术中无大血管及腹腔脏器损伤等严重并发症发生。结论成功建立经直肠NOTES辅助腹腔镜下肾切除术的动物模型，提示经直肠途径可成为NOTES入路的新选择。
Objective To establish a transrectal NOTES-assisted laparoscopic nephrectomy in a porcine model, and to evaluate its feasibility. Methods Six female pigs underwent transrectal NOTES-assisted laparoscopic nephrectomy （3 right, 3 left）. A 5- and 10-ram trocar were placed at the right and left margin of umbilicus. Pneumoperitoneum was achieved by either of the trocar. A 5-mm trocar was placed through the rectum into the abdominal cavity under the direct vision from a 5-mm flexible-tip 0o laparoscope inserted through the 5-mm troear at the margin of umbilicus. Dissection was performed using conventional laparoscopic instruments placed through the abdominal trocars under direct vision achieved by the 5-ram flexible-tip Oo laparoscope placed through the rectal troear. Renal artery, vein, and ureter were dissected and clamped by Hem-oqok or titanium clips. The specimen was placed inside a self-made retrieval bag and removed from rectum, and then rectal incision was closed by transrectal approach. Results Transrectal NOTES-assisted laparoscopic nephrectomy was successfully performed in all cases. The median operative time was 120（90-180） min. The median estimated blood loss was 40 （20-50） m]. No intra-abdominal organ injury was noted. Conclusions Transrectal NOTES-assisted laparoscopic nephrectomy appears to be a feasible surgical technique, which results in excellent cosmesis. This approach may be useful as an alternative to transvaginal access.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2013年第10期771-774,共4页
Chinese Journal of Urology
基金
基金项目：国家高技术研发计划（863计划）项目（2012AA021100）
江西省“赣鄱英才555工程”领军人才培养计划项目
江西省科技厅重大科技支撑计划项目（20121BBG70032）
江西省教育厅科技落地计划项目（KJLD12044）
江西省卫生厅科技计划项目（20111074,20121095）
赣南医学院重大科技计划项目（ZD2009003）
