经腹单孔多通道联合末端可弯3D腹腔镜行猪肾部分切除术的初步尝试  

Transperitoneal laparoendoscopic single-site nephrectomy combined with flexible 3-D laparoscope for partial nephrectomy in pigs:apreliminary experience

作　　者：刘冰[1] 王志向[1] 杨庆[1] 叶华茂[1] 鲍一[1] 吴震杰[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：《第二军医大学学报》2014年第7期769-773,共5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);上海市自然科学基金(11ZR1447800);军队临床高新技术重大项目(2010gxjs057);上海市重点学科项目~~

摘　　要：目的初步尝试经腹单孔多通道联合末端可弯3D腹腔镜行猪肾部分切除术,介绍用猪作为单孔腹腔镜肾部分切除术动物模型的经验和体会,探讨其可行性,总结操作难点,并总结末端可弯3D腹腔镜操作特点。方法雄性香猪1只,全麻后取平卧位。取经右侧腹直肌切口,长约3.5cm,依次逐层切开至腹腔后,应用Olympus单孔多通道Port建立操作通道。以14mmHg(1mmHg=0.133kPa)形成气腹,进入腹腔后打开侧腹膜,游离右肾下极及肾蒂。阻断肾动脉后切除右肾下极。间断"8"字全层缝合肾脏创面,开放血流后未见明显出血。将切除的右肾脏下极装入标本袋,从原切口取出。结果在不增加任何额外切口的情况下顺利完成手术,手术时间47min,其中总阻断时间21min(切除5min,缝合16min),术中出血约20mL。无任何术中并发症。结论单孔多通道经腹3D腹腔镜下肾部分切除术有一定难度,但手术总体安全、可行。联合末端可弯3D腹腔镜,使得手术图像立体感强,手术操作精确度高,能有效降低单孔器械"打架"及手眼协调难度。应用猪作为动物模型进行单孔多通道联合末端可弯3D腹腔镜肾部分切除术可以让外科医生有效积累手术经验及技巧。Objective To use transperitoneal laparoendoscopic single-site（LESS）partial nephrectomy combined with flexible 3-D laparoscope for partial nephrectomy in pigs,and to introduce our experience on LESS training in a pig model for partial nephrectomy.Methods A male pig was given general anesthesia and was put in a supine position.A 3.5cm incision was made through the right abdominal rectus. A multi- channel QuadPort（OlympusTM） was established. Artificial pneumoperitoneum was created by 14mmHg（1mmHg=0.133kPa）;the lower pole and the kidney pedicle of the right kidney were isolated.The lower pole of the right kidney was resected after the renal artery was blocked.Figure-8 sutures were used to close the wound,with no notable bleeding noticed after opening the blood.The specimen was enclosed in an endoscopic pouch and pulled out from the incision.Results The procedure was smoothly completed without any extra incision.The operating time was 47 min;the period of renal artery occlusion was 21 min（5 min for resection,16 min for stitching）;and the intraoperative blood loss was 20mL.There was no complication during the operation.Conclusion Our initial experience shows that 3D-LESS partial nephrectomy procedure is technically difficult,but it is safe,feasible and effective.Flexible 3D laparoscopy can provide clear 3D visualization,improving the operating accuracy and reducing the fighting of instruments.Thepig model used in this study can help surgeons to obtain experience on 3D-LESS partial nephrectomy.

关 键 词：肾部分切除术 单孔腹腔镜手术 3D腹腔镜手术 可弯3D腹腔镜 

分 类 号：R699.2[医药卫生—泌尿科学]