多通道操作套管在经阴道纯NOTES手术中的应用

龙大治; 江波; 邹晓峰; 张国玺; 肖日海; 袁源湖; 伍耿青; 王晓宁; 薛义军; 刘佛林; 吴玉婷; 徐辉; 杨军; 杨增祥; 刘林伟

doi:10.13201/j.issn.1001-1420.2015.10.003

多通道操作套管在经阴道纯NOTES手术中的应用

- 赣南医学院第一附属医院泌尿外科, 赣南医学院泌尿外科研究所(江西赣州, 341000)
基金项目:
国家高技术研发计划(863计划)项目(编号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(编号20121BBG70032

20132BAB205007

20151BBG70070)

江西省教育厅科技落地计划项目(编号KJLD12044)

江西省卫生厅科技计划项目(编号20111074

20121095)

赣南医学院重大科研课题(编号201109)

详细信息

通讯作者: 邹晓峰,E-mail:gyfyurology@126.com; 张国玺,E-mail:gyfyurology@126.com

中图分类号: R699.2;R608

收稿日期: 2015-07-21

Application of multichannel port in pure transvaginal NOTES

- Department of Urology, First Affiliated Hospital of Gannan Medical University, Gannan Medical University Institute of Urology, Ganzhou, Jiangxi, 341000, China

More Information

Corresponding authors: ZOU Xiaofeng ; ZHANG Guoxi

Received Date: 21 July 2015

摘要

摘要: 目的:探讨自主研发的国家专利产品多通道操作套管(Zou-Port)在经阴道纯NOTES手术中的应用价值。方法:自2011年4月开始应用Zou-Port施行经阴道纯NOTES手术20例,其中肾囊肿4例,左侧3例,双侧1例;重度肾积水并无功能肾15例,左侧3例,右侧12例;右肾肿瘤1例。分别施行经阴道纯NOTES肾囊肿去顶术、单纯肾切除术及根治性肾切除术。结果:本组20例,除1例经阴道纯NOTES肾切除术中在应用Zou-Port建立经阴道操作通道时分离钳戳破直肠壁外,其余19例腹部均未置Trocar,均完全经阴道完成手术,且未发生腹腔、盆腔脏器及大血管损伤等严重并发症;1例纯NOTES单纯肾切除术后发生右侧髂外动脉血栓,急诊成功行血栓取出术。经阴道纯NOTES肾囊肿去顶术平均手术时间为75(60~90)min,术中平均失血量25(20~50) ml;经阴道纯NOTES肾切除术平均手术时间185(160~320) min,术中平均失血量160(100~500) ml。患者阴道后穹窿切口均"Ⅱ/甲"愈合,19例成功完成手术患者体表均无切口或穿刺孔。术后随访6~52个月,无盆腔或腹腔感染、子宫脱垂等并发症。1例肾肿瘤患者无肿瘤复发或转移。结论:应用Zou-Port行经阴道纯NOTES手术安全可行,便利手术操作,降低了手术难度,能有效避免腹腔和盆腔脏器副损伤,临床效果良好。
- 经自然腔道内镜手术 /
- 经阴道途径 /
- 多通道操作套管
Abstract: Objective:To investigate the value of multichannel port (Zou-Port) developed independently with national patent in pure transvaginal natural orifice transluminal endoscopic surgery (NOTES).Method:A retrospective analysis of clinical data of 20 patients treated with pure transvaginal NOTES since April 2011 was performed. Four patients underwent pure transvaginal NOTES renal cyst decortication, including three cases on the left and one on the bilateral sides. Fifteen patients with severe hydronephrosis leading to a nonfunctioning kidney underwent pure transvaginal NOTES simple nephrectomy, including three cases on the left and in 12 on the right side. One patient with right renal carcinoma underwent pure transvaginal NOTES radical nephrectomy. A Zou-Port was deployed across the vaginal incision.Result:The procedures were successfully performed in all patients without additional trocars except for one patient who immediately converted to suprapubic-assisted laparoendoscopic single-site surgery (SA-LESS) nephrectomy because of rectal injury during the placement of the Zou-Port. There were no other intraoperative major complications. A major postoperative complication, right external iliac artery thrombosis occurred in one patient who underwent pure transvaginal NOTES simple nephrectomy. The mean operative time was 75 (range, 60-90) min and the mean estimated blood loss was 25 (range, 20-50) ml for pure transvaginal NOTES renal cyst decortication. The mean operative time was 185 (range, 160-320) min and the mean estimated blood loss was 160 (range, 100-500) ml for pure transvaginal NOTES nephrectomy. During[CM(48]the 6-52 months of follow-up period all the patients were in good condition. The posterior colpotomy incision healed up well. There were no scars on the abdominal wall in those 19 patients who underwent pure transvaginal NOTES successfully. There was no major postoperative complication such as infection in pelvic and abdominal cavity, umbilical hernia, or uterine prolapse. One patient who underwent radical nephrectomy for renal carcinoma was alive without evidence of tumor recurrence or metastasis.Conclusion:The application of Zou-Port in pure transvaginal NOTES can reduce the difficulty of operation, facilitate the surgical procedure, and avoid the abdominal and pelvic organs injury. It is effective, safe and feasible.
- natural orifice transluminal endoscopic surgery /
- transvaginal surgery /
- multichannel operating platform

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参考文献(18)

[1]	Kaouk J H, White W M, Goel R K, et al. NOTES transvaginal nephrectomy:first human experience[J]. Urology, 2009, 74(1):5-8.
[2]	邹晓峰, 张国玺, 肖日海, 等. 经阴道NOTES辅助腹腔镜下肾切除术[J]. 中华泌尿外科杂志, 2010, 31(12):810-813.
[3]	邹晓峰, 张国玺, 肖日海, 等. 经阴道NOTES辅助腹腔镜下肾上腺肿瘤切除术四例报告[J]. 中华泌尿外科杂志, 2010, 31(12):856.
[4]	Zou X F, Zhang G X, Xiao R H, et al. Transvaginal natural orifice transluminal endoscopic surgery (NOTES)-assisted laparoscopic adrenalectomy:first clinical experience[J]. Surg Endosc, 2011, 25(12):3767-3772.
[5]	邹晓峰, 杨军, 张国玺, 等. 经阴道NOTES辅助混合腔镜上尿路全切除术(附2例报告)[J]. 临床泌尿外科杂志, 2012, 27(10):721-724.
[6]	邹晓峰, 吴玉婷, 张国玺, 等. 经阴道自然腔道内镜手术辅助腹腔镜下肾切除术对女性性功能及生活质量影响的前瞻性研究[J]. 中华泌尿外科杂志, 2014, 35(7):531-534.
[7]	Kaouk J H, Haber G P, Goel R K, et al. Pure natural orifice translumenal endoscopic surgery (NOTES) transvaginal nephrectomy[J]. Eur Urol, 2010, 57(4):723-726.
[8]	邹晓峰, 张国玺, 肖日海, 等. 经阴道纯NOTES肾囊肿去顶术1例报告并文献复习[J]. 临床泌尿外科杂志, 2011, 26(3):161-164.
[9]	邹晓峰, 张国玺, 肖日海, 等. 经阴道纯NOTES肾切除术2例报告并文献复习[J]. 临床泌尿外科杂志, 2011, 26(9):641-644.
[10]	伍耿青, 邹晓峰, 张国玺, 等. 经阴道内镜根治性肾切除术1例报告[J]. 中国内镜杂志, 2013, 19(9):1006-1008.
[11]	Zou X F, Zhang G X, Yuan Y H, et al. Pure transvaginal natural orifice translumenal endoscopic surgery for renal cyst decortication:report of initial five cases[J]. Int J Urol, 2014, 21(1):64-68.
[12]	Xue Y, Zou X, Zhang G, et al. Transvaginal natural orifice transluminal endoscopic nephrectomy in a series of 63 cases:stepwise transition from hybrid to pure NOTES[J]. Eur Urol, 2015, 68(2):302-310.
[13]	邹晓峰, 张国玺, 袁源湖, 等. 耻骨上辅助经脐单孔腹腔镜技术在泌尿外科的应用价值(附57例报告)[J]. 临床泌尿外科杂志, 2011, 26(7):481-484.
[14]	Zou X F, Zhang G X, Xue Y J, et al. Suprapubic-assisted laparoendoscopic single-site surgery (LESS) in urology:our experience[J]. BJU Int, 2013, 112(2):E92-98.
[15]	Laydner H, Autorino R, Isac W, et al. Robotic retroperitoneal transvaginal natural orifice translumenal endoscopic surgery (NOTES) nephrectomy:feasibility study in a cadaver model[J]. Urology, 2013, 81(6):1232-1237.
[16]	Sánchez-Margallo F M, Pérez F J, Sánchez M A, et al. Transvaginal NOTES-assisted laparoscopic nephrectomy:a survival study in a sheep model[J]. Surg Endosc, 2012, 26(4):926-932.
[17]	Bazzi W M, Wagner O, Stroup S P, et al. Transrectal hybrid natural orifice transluminal endoscopic surgery (NOTES) nephrectomy in a porcine model[J]. Urology, 2011, 77(3):518-523.
[18]	程小丽, 宋成利. 单孔腹腔镜手术器械研究的最新进展[J]. 中国组织工程研究与临床康复, 2011, 15(25):4669-4674.