输尿管“拉出式”技术在根治性肾输尿管全切术中应用的实验研究  

Safety of the "pluck" technique in managing bladder cuff in nephroureterectomy for upper urinary tract urothelium carcinoma

作　　者：庞昆[1] 刘世博[2] 邵怡[1] 李维国[1] 卓见[1] 王振梅 夏术阶[1] 孙晓文[1] 

机构地区：[1]上海交通大学附属第一人民医院泌尿外科,上海200080 [2]沈阳市肿瘤医院泌尿科,辽宁沈阳110042 [3]临沂市马站人民医院,山东临沂276403

出　　处：《现代泌尿外科杂志》2012年第5期455-458,共4页Journal of Modern Urology

摘　　要：目的探讨输尿管"拉出式"技术在根治性肾输尿管全切术中应用的安全性。方法建立动物试验模型,分别测量输尿管末端封闭后的耐受压力和肾输尿管全切手术中输尿管末端所承受的压力。①输尿管末端封闭后的耐受压力测定:取6只猪的离体输尿管12根,分为电凝组和铥激光组,分别通过电凝或铥激光封闭输尿管末端。测量封闭后的输尿管末端所耐受压力并进行两组间比较。②肾输尿管全切手术中输尿管末端所承受压力的测定:取3只猪,行肾输尿管全长切除术,测量手术过程中输尿管末端承受的压力,并与输尿管末端封闭后的耐受压力进行比较。结果两组猪离体输尿管,末端电凝封闭组可承受的平均压力为(104.32±25.01)cmH2O,铥激光封闭组可承受的平均压力为(74.81±23.32)cmH2O。两组间的差异无统计学意义(P>0.05)。肾输尿管全长切除术中的不同阶段,测得对输尿管末端产生的压力不同。其中,在寻找辨认输尿管时,压力最高为(35.88±7.57)cmH2O;其次为游离输尿管时和牵拉输尿管时,分别为(34.95±8.75)cmH2O和(33.08±7.00)cmH2O。手术过程中对输尿管末端造成的最高压力,均小于铥激光及电凝封闭后输尿管末端所能耐受的平均压力(P<0.05)。结论上尿路上皮癌的肾输尿管全切手术中,采用电凝或铥激光首先封闭输尿管末端并行输尿管膀胱壁内段切除,然后行肾输尿管全长切除术的输尿管"拉出式"技术安全有效,且操作简单,该种术式的安全性得到验证。铥激光封闭输尿管末端的方法可以达到与传统的电凝相类似的效果,而铥激光具有切割精确、止血效果好、切割效率高的优势,在临床上有广泛的应用前景。Objective To study the safety of ＂pluck＂ technique in managing bladder cuff in nephroureterectomy for upper urinary tract urothelium carcinoma. Methods The animal experiment was divided into 2 parts：seal effect measurement model and surgical pressure measurement model. ①12 ureters from 6 pigs were collected and divided into Electrical group and Thulium laser group. The burst of different groups were measured to compare the seal effect. ②3 pigs received nephroureterectomy with a piezometer connected to the bladder orifices to measure the maximum pressure of the nephroureterectomy,and then the burst pressure and the maximum pressure during the surgery were measured to study the safety of＂pluck＂ technique. Results The mean burst pressure sealed by electrosurgical loop and thulium laser technique was （104.32±25.01）cmH20 and （74.81±23.32）cmHz O respectively, with no statistically significance （P〉0.05）. The max pressure during the surgery occurred when the surgeons were looking for the ureter,with a pressure of （35.88±7.57）cmH2 O. When the ureter was separated, the pressure was （34.95±8.75）cmHzO, When the ureter was plucked,the pressure could reach （33.08±7.00）cmH20. All pressures measured during the surgery were statistically below the burst pressure （P〈0.05）. Conclusions The＂pluck＂ technique is safe and reliable for the surgical treatment of upper urinary tract urothelium carcinoma. Besides,with the advantages of good hemostasis,accurate and rapid tissue cutting,thulium laser is an available optional treatment.

关 键 词：铥激光技术 上尿路尿路上皮癌 输尿管壁内段切除 封闭效果 爆裂压力测定 

分 类 号：R693.4[医药卫生—泌尿科学]