经直肠自然腔道内镜手术辅助腹腔镜下肾切除术猪动物模型的构建  

Transrectal NOTES-assisted laparoscopic nephrectomy in a porcine model

作　　者：邹晓峰[1] 张国玺[1] 张旭[2] 马鑫[2] 徐辉[1] 朱刚[3] 林天歆[4] 牛远杰[5] 单戈[6] 袁源湖[1] 肖日海[1] 伍耿青[1] 王晓宁[1] 薛义军[1] 刘佛林[1] 刘全亮[1] 

机构地区：[1]赣南医学院第一附属医院泌尿外科赣南医学院泌尿外科研究所,江西赣州341000 [2]北京解放军总医院泌尿外科 [3]卫生部北京医院泌尿外科 [4]中山大学附属第二医院泌尿外科 [5]天津医科大学第二医院泌尿外科 [6]黑龙江省森工总医院泌尿外科

出　　处：《中华泌尿外科杂志》2013年第10期771-774,共4页Chinese Journal of Urology

基　　金：基金项目：国家高技术研发计划（863计划）项目（2012AA021100）;江西省“赣鄱英才555工程”领军人才培养计划项目;江西省科技厅重大科技支撑计划项目（20121BBG70032）;江西省教育厅科技落地计划项目（KJLD12044）;江西省卫生厅科技计划项目（20111074,20121095）;赣南医学院重大科技计划项目（ZD2009003）

摘　　要：目的评价经直肠自然腔道内镜手术（NOTES）辅助腹腔镜下肾切除术猪动物模型的应用价值。方法健康雌性普通猪6只，质量42～48kg，中位质量46kg。行经直肠NOTES辅助腹腔镜下肾切除术，左侧3例，右侧3例。全麻。取70。侧卧位，双后肢外展固定。于脐两侧缘分别置入5mm和10mm套管，距齿状线上方约2cm处置入5mm套管。自直肠套管置入腹腔镜，脐缘两套管置入操作器械。用电凝钩和吸引器锐性和钝性结合行肾脏游离，逐步显露肾蒂，用Hem—o—lok或钛夹阻断肾动、静脉及输尿管，完整切除肾脏，装入自制标本袋，扩大直肠切口后取出。结果本组6例手术均成功完成，未中转普通腹腔镜或开放手术，未新增操作通道。手术时间90～180rain，中位时间120min；术中失血量20～50ml，中位失血量40ml。术中无大血管及腹腔脏器损伤等严重并发症发生。结论成功建立经直肠NOTES辅助腹腔镜下肾切除术的动物模型，提示经直肠途径可成为NOTES入路的新选择。Objective To establish a transrectal NOTES-assisted laparoscopic nephrectomy in a porcine model, and to evaluate its feasibility. Methods Six female pigs underwent transrectal NOTES-assisted laparoscopic nephrectomy （3 right, 3 left）. A 5- and 10-ram trocar were placed at the right and left margin of umbilicus. Pneumoperitoneum was achieved by either of the trocar. A 5-mm trocar was placed through the rectum into the abdominal cavity under the direct vision from a 5-mm flexible-tip 0o laparoscope inserted through the 5-mm troear at the margin of umbilicus. Dissection was performed using conventional laparoscopic instruments placed through the abdominal trocars under direct vision achieved by the 5-ram flexible-tip Oo laparoscope placed through the rectal troear. Renal artery, vein, and ureter were dissected and clamped by Hem-oqok or titanium clips. The specimen was placed inside a self-made retrieval bag and removed from rectum, and then rectal incision was closed by transrectal approach. Results Transrectal NOTES-assisted laparoscopic nephrectomy was successfully performed in all cases. The median operative time was 120（90-180） min. The median estimated blood loss was 40 （20-50） m]. No intra-abdominal organ injury was noted. Conclusions Transrectal NOTES-assisted laparoscopic nephrectomy appears to be a feasible surgical technique, which results in excellent cosmesis. This approach may be useful as an alternative to transvaginal access.

关 键 词：经自然腔道内镜手术(NOTES) 经直肠途径 肾切除术 动物模型 

分 类 号：R-332[医药卫生]