经阴道NOTES辅助腹腔镜肾切除术猪动物模型的构建

张国玺; 邹晓峰; 张旭; 马鑫; 徐辉; 朱刚; 林天歆; 牛远杰; 单戈; 袁源湖; 肖日海; 伍耿青; 王晓宁; 薛义军

经阴道NOTES辅助腹腔镜肾切除术猪动物模型的构建

- 1. 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);
- 2. 解放军总医院泌尿外科;
- 3. 卫生部北京医院泌尿外科;
- 4. 中山大学附属第二医院泌尿外科;
- 5. 天津医科大学第二医院泌尿外科;
- 6. 黑龙江省森工总医院泌尿外科
基金项目:
国家高技术研发计划（863计划）项目（编号SQ2011AAJY2801）；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；江西省卫生厅重大科技计划项目（编号20104008）

详细信息

通讯作者: 邹晓峰,E-mail:gyfyurology@126.com; 张旭,E-mail:xzhang@foxmail.com

中图分类号: R730.49

收稿日期: 2012-06-12

Transvaginal NOTES-assisted laparoscopic nephrectomy in a porcine model

- 1. Department of Urology, the First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, 341000, China;
- 2. Department of Urology, Clinical Division of Surgery, Chinese PLA General Hospital;
- 3. Department of Urology, Beijing Hospital of the Ministry of Health;
- 4. Department of Urology, Second Affiliated Hospital of Zhongshan University;
- 5. Department of Urology, the 2nd Hospital of Tianjin Medical University;
- 6. Department of Urology, General Hospital of Forest and Industry Bureau of Heilongjiang province

More Information

Corresponding authors: ZOU Xiaofeng ; ZHANG Xu

Received Date: 12 June 2012

摘要

摘要: 目的：介绍构建经阴道NOTES辅助腹腔镜肾切除术猪动物模型的经验和体会，并评价其应用价值。方法：本组选择6头健康雌性小型猪，中位重量46（42~48） kg。全麻，取70°侧卧位，双后肢外展。于脐两侧缘分别置入一5 mm和10 mm trocar。自阴道后穹窿置入一5 mm trocar。自阴道trocar置入腹腔镜，脐缘两trocar置入操作器械。用电凝钩和吸引器锐性和钝性相结合游离肾脏，逐步显露肾蒂，用Hem-o-lock和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，扩大阴道后穹窿切口取出。结果：6例经阴道NOTES辅助腹腔镜猪肾切除术均成功完成，未中转标准腹腔镜或开放手术，亦未另增操作通道。其中左侧3例，右侧3例。中位手术时间100（70~150） min。其中建立通道中位时间10（9~22） min，肾脏切除中位时间15（7~30） min，标本取出中位时间65（40~80） min；术中中位失血量30（20~40） ml。术中无大血管及腹腔脏器损伤等严重并发症发生。结论：建立经阴道NOTES辅助腹腔镜肾切除术的动物模型可行。该模型较真实地模仿人体NOTES的操作过程，是现阶段进行学员培训和特殊器械研发较适宜的方式。
- 经自然腔道内镜手术 /
- 经阴道途径 /
- 肾切除术 /
- 动物模型
Abstract: Objective: To introduce our experience in transvaginal NOTES-assisted laparoscopic nephrectomy in a porcine model and access its value.Method: Six female pigs underwent transvaginal NOTES-assisted laparoscopic nephrectomy(3 right, 3 left). A 5 and 10 mm trocar were placed at the right and left margin of umbilicus. The vaginal mucosa in the posterior vaginal fornix was opened by a chiastic 0.5 cm incision, and a 5 mm trocar was inserted into the abdominal cavity under the direct vision from a 5 mm flexible-tip 0° laparoscope inserted through the 5 mm trocar at the margin of umbilicus. Dissection was performed using operating apparatus placed in the abdominal trocars, under direct vision achieved by the 5 mm flexible-tip 0° laparoscope placed through the vaginal trocar. The renal artery, vein, and ureter were blocked by Hem-o-lock and titanium clips. The specimen was placed inside a homemade bag and removed via the incision of posterior vaginal fornix under direct vision with an optic in the abdominal trocar. The vaginal wound was closed using a running 2-0 absorbable suture.Result: A total of 6 transvaginal NOTES-assisted laparoscopic nephrectomies were successfully performed in this series. The median operative time was 100(range 70 to 150)min. The median estimated blood loss was 30(range 20 to 40) ml. On necropsy, no intraabdominal injuries were noted.Conclusion: Transvaginal NOTES-assisted laparoscopic nephrectomy in a porcine model appears to be feasible, which is suitable to NOTES training for beginners and the development of special instruments.
- transvagina /
- natural orifice transluminal endoscopic surgery /
- nephrectomy /
- animal

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