经腹单孔末端可弯3D腹腔镜行猪肾盂输尿管成形术的动物实验:附视频  

Transperitoneal laparoendoscopic single-site(LESS) pyeloplasty in pig using 3D laparoscope with deflectable tip

作　　者：刘冰[1] 鲍一[1] 王志向[1] 汪洋[1] 吕晨[1] 杨庆[1] 叶华茂[1] 吴震杰[1] 王林辉[1] 孙颖浩[1] 

机构地区：[1]第二军医大学附属长海医院泌尿外科,上海200433

出　　处：《中华腔镜泌尿外科杂志（电子版）》2015年第1期10-13,共4页Chinese Journal of Endourology(Electronic Edition)

基　　金：国家自然科学基金项目(81172447);上海市自然科学基金(11ZR1447800)

摘　　要：目的初步尝试经腹单孔多通道末端可弯3D腹腔镜行猪肾盂输尿管成形术,评估3D单孔腹腔镜肾盂输尿管离断成形术的可行性,总结使用末端可弯3D腹腔镜的经验及操作难点。方法猪全麻后取仰卧位,向左摇床30°,取经右侧腹直肌切口,长约3 cm,逐层切开至腹腔后,置入Olympus单孔多通道系统(Quad-Port)建立操作通道。充入CO2,气腹压达14 mm Hg,置入Olympus 10 mm末端可弯3D腹腔镜及预弯器械,打开侧腹膜,沿肾盂向下游离3 cm长的输尿管,离断并上下纵行剖开1 cm。用4-0可吸收线连续缝合输尿管前壁并打结,翻转输尿管180°后连续缝合后壁。完成吻合前置入双J管,最后间断缝合3针完成缝合。结果在不增加额外通道的情况下顺利完成手术,手术时间68 min。为了实践练习单孔腹腔镜下缝合技术,共缝合猪输尿管11针,用时53 min。术中出血少,无术中并发症。结论经腹单孔多通道3D腹腔镜下肾盂输尿管成形术安全、可行,但手术操作难度较大。配合使用末端可弯3D腹腔镜及可弯、预弯器械,使得手术图像立体感强,视野更加灵活,手术操作精确度高,有效降低单孔器械"打架"及手眼协调难度。Objective： To make an initial attempt for transperitoneal single-port laparoscopic pyeloplasty in pig using 3D laparoscope with deflectable tip, in order to assess the feasibility and present our experiences of LESS pyeloplasty using 3D laparoscope with deflectable tip. Methoda Pig was in the supine position and the surgical bed was leaned to the left at 30 degrees, a 3 cm incision through the right rectus was undertaken and a multi-channel Quad-Port （Olympus） was installed. Carbon dioxide was instilled through the port to a maximum pressure of 14 mmHg and the laparoscope with deflectable tip was put in through the port. After peritoneal incision lateral and locating the ureteropelvic, 3cm-long ureter was dissected. Then the ureter was mutilated and a longitudinal incision was made. Then the ureter was subjected to continuous suturing the antetheca and the paries posterior with 4-0 absorbable suture and a double-J stent was inserted before the last 3 interrupted suturing. Results The pyeloplasty was pertbrmed successfully without extra skin incision. The operating time was 68 min. In order to practice suturing ureter totally 11 sutures were made in 53 minutes and there was little blood loss and no complication during the operation. Conclusions 3D-LESS pyeloplasty procedure is safe, feasible and effective while the suture and knotting are somewhat difficult. The 3D laparoscope with deflectable tipprovides clear 3D visualization which improves the precision of complex surgical manoeuvres and pre-curved instruments decrease the fighting of instruments.

关 键 词：肾盂输尿管成形术 单孔 末端可弯 3D 腹腔镜 

分 类 号：R699[医药卫生—泌尿科学]