| 摘要: |
| 目的 尝试完成经尿道途径辅助下单孔腹腔镜猪全膀胱切除加回肠代膀胱术,探讨该操作的可行性,总结操作经验。方法 体质量约为30 kg的雌性香猪,全麻后仰卧位,平脐水平,经右侧腹直肌纵行切开2 cm长皮肤切口,钝性分开腹直肌并切开腹膜。置入SILS单孔多通道平台后,建立气腹。超声刀配合可弯分离钳游离膀胱周围组织,并离断双侧输尿管。末端可弯电钩离断尿道,完成膀胱切除。在输尿管镜的引导下,经尿道置入12 mm的普通腹腔镜套管。选择合适肠管后,经尿道套管置入直线切割器进行离断。单孔腹腔镜下完成小肠侧侧吻合和左侧输尿管小肠吻合。经尿道套管取出膀胱标本,缝闭尿道残端。取出SILS单孔多通道平台,一并将右侧输尿管及拟行造口的小肠输出袢带出。体外完成右侧输尿管和输出袢吻合,并将小肠黏膜外翻完成造口。结果 完成3例动物试验,手术时间210~335 min,平均(275±63) min,未增加额外套管。术毕,腹壁除正常肠造口外,无其他手术切口。结论 经尿道途径辅助下有利于完成高难度的单孔腹腔镜猪全膀胱切除加回肠代膀胱重建术,但手术操作难度较大。 |
| 关键词: 全膀胱切除术 单孔腹腔镜手术 经自然腔道内镜手术 经尿道途径 |
| DOI：10.3724/SP.J.1008.2011.01065 |
| 投稿时间：2011-05-31修订日期：2011-08-25 |
| 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). |
|
| Single-port laparoscopic cystectomy and intracorporeal urinary diversion assisted by transurethral access: preliminary study |
| LU Xin△,ZHANG Zhen-sheng△,YANG Bo,WANG Hui-qing,XIAO Liang,CAO Zhi,XU Chuan-liang,WANG Lin-hui,SUN Ying-hao* |
(Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
△Co-first authors.
*Corresponding author.) |
| Abstract: |
| Objective To make attempt for “no scar” cystectomy by pure LESS (laparoendoscopic single-site) surgery and transurethral NOTES (natural orifice transluminal endoscopic surgery) in pigs, so as to assess the feasibility and summarize the experience. Methods Female pigs weighing 30 kg were given general anesthesia. A 2 cm incision was made through the right lateral border of the rectus muscle, and the subcutaneous tissues and muscle layer were dissected bluntly with the Kelly clamp. The SILS port was introduced into the peritoneal cavity and the pneumoperitoneum was established. The bladder was dissected by the flexible forceps and scalpel. And the ureters and urethra were divided. Under the guidance of ureteroscopy, a 12 mm trocar was introduced into the urethra. Through the transurethral access, the small intestine was divided by two Endo GIAs. The lateral-lateral anastomosis of intestine and the left side of ureter-intestinal anastomosis were performed with assistance of the transurethral access. After the specimens were retracted, the urethra was closed by 2-0 suture. After the SILS port was removed, the right ureter and the small intestine for the stoma were pulled out of the peritoneal cavity. The right side of ureter-intestinal anastomosis was done outside of the body. Then the stoma was performed. Results Three cases were performed in a mean of (275±63) min (ranging from 210-335 min) without additional trocars. Except for the stoma,there were no other incisions on the surface of the abdominal wall. Conclusion This “no scar” LESS radical cystectomy can be performed successfully with assistance of the transurethral access in pigs, but the operation is technically difficult. |
| Key words: radical cystectomy laparoendoscopic single-site surgery natural orifice transluminal endoscopic surgery transurethral access |
