| 摘要: |
| 目的探讨联合经膀胱和胃路径进行猪肾脏切除术的可行性,总结操作经验。方法选取3只雌香猪,在输尿管硬镜下剪开膀胱前壁,并置入自制经膀胱Trocar,建立经膀胱路径; 在输尿管镜引导下,利用高频针状电刀穿刺胃壁,用球囊扩张后导入胃镜。在胃镜的引导下,经膀胱Trocar放入腹腔镜超声刀、剪刀、钛夹,完成肾切除术。结果成功进行3只雌香猪6个肾脏的切除术,手术时间(132±10.5)min,无明显出血,无明显并发症发生。第1例雌香猪的右肾静脉在用超声刀离断时出现出血,以钛夹处理,后5例肾脏血管处理前均以钛夹阻断后剪刀离断。结论联合经膀胱和胃联合路径可顺利切除猪肾脏,但术后未取出肾脏和关闭膀胱及胃壁穿刺口,仍需进一步研究改进。 |
| 关键词: 经自然腔道内镜手术 经膀胱 经胃 肾切除术 |
| DOI：10.3724/SP.J.1008.2010.0642 |
| 投稿时间：2009-12-01修订日期：2010-04-05 |
| 基金项目:国家科技部重大项目(20082X09312-025),上海市重点学科基金. |
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| Experimental nephrectomy via combined transgastric and transvesical approach in porcine |
| YANG Bo, WANG Hui-qing, WANG Lin-hui, XU Bin, XIAO Liang, ZHOU Tie, SUN Ying-hao* |
| (Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China) |
| Abstract: |
| ObjectiveTo assess the feasibility of nephrectomy via combined transgastric and transvesical approach in a porcine model, and to summarize our experience.MethodsThree female pigs were used in this study. The transvesical access was established using ureteroscope. The vesical hole was enlarged with the dilator of ureteroscope sheath and a self-designed Trocar was inserted. The gastroscope was inserted through a hole on gastric wall, which was made using a needle knife and dilator under ureteroscopy. The ultrasound knife, scissor and clips were introduced via the Trocar, and the nephrectomy was completed under the guidance of gastroscope. ResultsThe six kidneys of the three pigs were successfully resected, with the operation time being (132±10.5) min, without noticeable hemorrhage or complications. Mild hemorrhage occurred after ultrasonic ligation in the first nephrectomy, and was managed by clips. Clips were used to block the vessels before resection for the remaining five kidneys.ConclusionOur method via combined approach is technically feasible for nephrectomy in a porcine model, but the kidneys have not been taken out and the puncture wounds on the bladder and gastric wall have not been closed, so further study is still needed. |
| Key words: natural orifice transluminal surgery transvesical access transgastric access nephrectomy |
