一套自制器械在腹腔镜肾盂输尿管离断成形术中的应用  

A new set of instruments for laparoscopic pyeloplasty： development and assessment Y

作　　者：杨波[1] 王辉清[1] 肖亮[1] 李云[1] 许传亮[1] 王林辉[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：《中华实验外科杂志》2012年第12期2426-2428,共3页Chinese Journal of Experimental Surgery

基　　金：上海市市级医院新兴前沿技术联合攻关项目（SHDCl2-010115）

摘　　要：目的观察活体动物试验验证自制的一套手术器械能否降低腹腔镜肾盂输尿管离断成形术（LP）的难度，节约手术时间。方法根据以往的手术经验，针对LP手术中的纵行剖开输尿管、吻合输尿管V形底部、留置双J管这3个关键步骤，白行研发出腹腔镜下直角剪、梅花形撑开器和弧形金属导管3种器械。设计动物试验，由4名术者对这3种自制器械进行评估，通过视频记录相关步骤的操作时间，参考视觉模拟评分（VAS）模式进行受益评分（HS）和新增困难评分（NDS）。结果16例次手术均顺利完成，其中经腹腔途径8例，经腹膜后途径8例。在3种器械中，腹腔镜下直角剪获得最高主观评价，HS为6．75分，NDS为1．25分；弧形金属导管也获得了正面的评价，HS为4．25分，NDS为1．75分；梅花形撑开器得到了负面评价，HS仅为1．50分，而NDS为6．50分，2名术者同时认为难以将撑开器顺利置人输尿管腔内，另1名术者认为输尿管镜下取石篮也许更方便使用。而且，视频回顾研究也证明前两种器械能缩短操作时间。结论腹腔镜下直角剪和弧形金属导管能简化操作步骤，降低手术难度，达到了设计目的。而梅花形撑开器无助于操作，需要重新设计和进一步改进。Objective To overcome some difficulties and technical challenges encountered during pure laparoscopic pyeloplasty, we designed a set of new instruments and assessed them using porcine model. Methods According to the ideas from the surgeons, our medical engineer designed three new instru- ments, including the right angle laparoscopy scissors, the petal-shape ureter dilator and the guide tube. Four experienced laparoscopic experts were involved in a no survival porcine study to assess the help of these new instruments. Four experiments were conducted on live pigs that weighed 22 to 25 kg at the same time. After general anesthesia was administered, transperitoneal ureteroureterostomy was performed using standard laparoscopic instruments, including placing the double J stent anterograde. Then, the opposite lat- eral was done by the same surgeon plus these new devices for side-by-side comparative analysis. All experts were interviewed to assess these new instruments by the questionnaire based on the visual analog scale （VAS） from 1 （none） to 10 （very much）. Results The procedures were all technically successful The right angle laparoscopy scissors and the guide tube were accepted by all participants and the Help Scores was 6. 75 and 4. 25 respectively, at the same time the New Difficulty Score 1.25 and 1.75. However, the petal-shape ureter dilator got 1.50 Help Score and 6. 50 New Difficulty Score, these surgeons made a negative comment and one of surgeons recommended the stone basket more suitable. Conclusion The right angle laparoseopy scissors and the guide tube may be helpful to minimize some difficulties in pure laparoseopic pyeloplasty. The petal-shape ureter dilator needs improvement.

关 键 词：肾盂输尿管成形术 腹腔镜手术 器械 猪 

分 类 号：R699[医药卫生—泌尿科学]