| 摘要: |
| 目的 在猪模型实行经膀胱和胃联合路径下的肾部分切除术,并应用V-loc线缝合肾脏缺损,以进一步评估联合经膀胱和胃路径手术的安全性和可行性。方法 利用雌香猪3只,在输尿管硬镜下剪开膀胱前壁,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,游离肾脏动静脉,置入血管阻断夹阻断肾动脉血供后,利用末端可弯剪刀切除部分肾下极实质。经皮置入2-0 V-loc线,连续缝合关闭肾脏缺损,恢复肾脏血供。置入拇指手套,装入标本并从膀胱取出。结果 完成6例肾脏手术,其中第1例因血管阻断不全,术中严重出血失去视野而改传统腹腔镜术。余5例均顺利完成,平均手术时间174(140～220) min,温缺血时间21(17～28) min,未见明显出血。切除肾实质大小平均1.5 cm×1.5 cm。结论 经膀胱和胃联合路径肾部分切除术难度极大,但在应用V-loc线和辅助针状腹腔镜器械后可以较方便地完成。其临床应用前景还需要进一步的研究验证。 |
| 关键词: 经自然腔道内镜手术 经膀胱路径 经胃路径 肾部分切除术 |
| DOI： |
| 投稿时间：2013-02-15修订日期：2013-07-01 |
| 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） |
|
| Combined transgastric and transvesical approach for porcine partial nephrectomy and application of V-loc suture |
| WANG Hui-qing1△,CAO Bin2△,YANG Bo1△,GUO Fei1,XIAO Liang1,XU Bin1,WANG Lin-hui1,SUN Ying-hao1* |
(1. Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
2. Department of Urology,People’s Hospital of Jingjiang City, Jingjiang 214500, Jiangsu, China
△Co-first authors.
*Corresponding author.) |
| Abstract: |
| Objective To perform partial nephrectomy via combined transgastric and transvesical approach in porcine and to use V-loc suture for suturing the renal defect, so as to further assess the safety and feasibility of combined transgastric and transvesical approach. Methods Three female pigs were used in this study. The transvesical access was established by incising the anterior wall of the bladder under ureteroscope, and a self-designed Trocar was inserted. Under the guidance of ureteroscopy, the transgastric access was established by a needle knife with cautery, and the gastroscope was introduced after balloon dilation. Under the guidance of gastroscope, laparoscopic ultrasonic scalpel was introduced via the bladder Trocar; the kidney artery and vein were separated, the arteries were blocked and some lower part of renal parenchyma was resected; and the wound was closed by 2-0 V-loc suture which was introduced percutaneously. The specimens were collected from the bladder. Results Six partial nephrectomy procedures were done in the 3 pigs. The first case was transferred to traditional laparoscopy due to incompleted blocking of the artery, bleeding and loss of vision. The rest 5 cases were successfully completed, with a mean operation time of 174 min(140-220 min), a warm ischemia time of 21 min (17-28 min), and with no significant bleeding. The average size of incised tissue was 1.5 cm×1.5 cm. Conclusion Partial nephrectomy via combined transgastric and transvesical approach is extremely difficult, but it can be done by using the V-loc suture and auxiliary needle laparoscopic instrument; however, its clinical prospect still needs further verification. |
| Key words: natural orifice transluminal endoscopic surgery transvesical approach transgastric approach partial nephrectomy |
