| 摘要: |
| 目的尝试预留线关闭猪经膀胱自然腔道内镜手术(natural orifice transluminal endoscopic surgery, NOTES)切口，探讨其可行性、安全性，总结操作经验，为后续临床应用奠定基础。方法雌香猪5只，全麻下置入自制膀胱鞘至膀胱。在输尿管镜的引导下，穿刺针穿刺膀胱顶前壁到腹下壁，预留2根关闭线，一端在腹壁，一端在尿道。完成经膀胱NOTES手术后将关闭线腹壁端拉至膀胱鞘外打结，拖动尿道端，使腹壁端线结固定在膀胱外壁，然后尿道端打结，由推结器将结推至膀胱内壁，重复推结完成关闭膀胱内切口。采用直视观察和膀胱充水方法检测膀胱切口关闭效果。结果共完成5例猪实验。因动物体质量和体型过大、膀胱切口选择太靠近膀胱颈口及丝线容易起绒等导致前2例失败。后3例顺利完成，手术时间分别为45、30、25 min，切口关闭效果良好。结论预留线关闭经膀胱NOTES手术切口安全可行、操作简单、取材方便，无需特殊手术器械，值得深入研究。 |
| 关键词: 经自然腔道内镜手术 经膀胱途径 切口关闭 |
| DOI：10.3724/SP.J.1008.2011.0490 |
| 投稿时间：2011-01-19修订日期：2011-03-14 |
| 基金项目:上海市市级医院新兴前沿技术联合攻关项目(SHDC12010115),军队临床高新技术重大项目(2010gxjs057). |
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| Reserved sutures for incision closure of transvesical natural orifice transluminal endoscopic surgery in pigs |
| WANG Hui-qing△,YANG Bo△,XIAO Liang,MU Yan-qing,WU Zhen-jie,XU Bin,WANG Lin-hui,XU Chuan-liang,SUN Ying-hao* |
| (Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China) |
| Abstract: |
| ObjectiveTo close the incision of transvesical natural orifice transluminal endoscopic surgery (NOTES) with reserved sutures in pigs, and to assess the feasibility and safety of the technique, so as to lay a foundation for future clinical application.MethodsFive female pigs were inserted with self-made Trocar into the bladder under general anesthesia. Guided by ureteroscope, the needle passed the top wall of the anterior bladder and reached the abdominal wall, with two suture ends reserved for closure, one at the abdominal wall and the other in the urethra(out of Trocar). After finishing the transvesical NOTES, we pulled the suture end at the abdominal wall to the bladder and knotted outside the Trocar; then we dragged the urethra suture end to make the knot on the abdominal wall locating on the lateral wall of bladder, and then the urethral suture was knotted in Trocar and the knot was pushed to the bladder wall using a knot pushing device; finally the bladder incision was closed. The closure of the bladder incision was observed and tested with water filling method.ResultsThe first two cases failed due to the overweight and large size of the pigs, or because the bladder incision was to close to the bladder neck, or due to the poor quality of the suture. The procedures were successful in the following 3 pigs, with the operation time periods being 45 min, 30 min, and 25 min, and with satisfactory closure.ConclusionReserved suture for incision closure of transvesical NOTES procedure is safe and feasible; the technique is easy to perform and needs no special surgery devices; and it deserves further study. |
| Key words: natural orifice transluminal endoscopic surgery transvesical access closure perforation |
