单孔腹腔镜下经膀胱根治性切除猪前列腺的初步尝试  

Single-port laparoscopic transvesical prostatectomy in pigs

作　　者：杨波[1] 王辉清[1] 肖亮[1] 徐斌[1] 王林辉[1] 许传亮[1] 孙颖浩[1] 

机构地区：[1]第二军医大学长海医院泌尿外科,上海200433

出　　处：《第二军医大学学报》2011年第2期195-197,共3页Academic Journal of Second Military Medical University

基　　金：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)~~

摘　　要：目的尝试单孔腹腔镜下经膀胱根治性切除猪前列腺,探讨其可行性,总结操作难点,为后续临床应用奠定基础。方法采用雄性未阉割香猪,全麻下进行膀胱外翻皮肤造口;将TriPort单孔多通道系统经造口处置入膀胱并固定;建立气膀胱后,用传统腹腔镜器械模拟人经膀胱前列腺根治性切除术;经膀胱完成膀胱内口与尿道吻合,经皮肤造口取出前列腺标本后关闭膀胱和腹腔。结果共完成了6例动物实验,前3例失败,原因为膀胱操作空间无法保证、吻合操作失败等;后3例均顺利完成,手术时间分别是190、160、110min,前列腺完整切除,间断吻合6针恢复尿道连续性。结论单孔腹腔镜下经膀胱猪前列腺根治性切除技术可行,但操作难度较大,鉴于猪解剖结构与人存在较大差异,需进一步在尸体模型上进行类似尝试,目前尚不适合向临床阶段过渡。Objective To assess the feasibility of the single-port laparoscopic transvesical prostatectomy in pigs, and to summarize the technique difficulties, so as to lay a foundation for future clinical application. Methods Six uncastrated male pigs were used in this study. The skin stomas were made through bladder exstrophy and the TriPort system was inserted into the bladder. Radical prostatectomy was performed as did in human using laparoscopic instruments through the TriPort system after inflating the bladder. The bladder and abdomen were closed after vesicourethral anastomosis, and the prostate specimens were removed through the skin stoma. Results The first three procedures failed due to inappropriate positioning of TriPort system, limited space of bladder, and the high tension of vesicourethral anastomosis. The other 3 procedures were successful, with the periods used being 190 min, 160 min, and 110 rain. The whole prostates were resected completely, and the completeness of the urinary tract was recovered using interrupted suture （6 sutures）. Conclusion The single-port laparoseopic transvesical prostatectomy is a feasible procedure, but there are technical difficulties. Further experiments are needed on human cadavers before clinical application.

关 键 词：前列腺根治性切除术 单孔腹腔镜手术 经膀胱途径 

分 类 号：R699[医药卫生—泌尿科学]