不同切口在孤肾猪选择性肾段动脉钳夹阻断模型中的可行性  

Feasibility of different incision to establish a solitary-kidney porcine model of selective segmental renal artery clamping

作　　者：徐述雄[1,2] 王元林[2] 储铸钢 徐元高[2] 石华[2] 李凯[2] 孙兆林[2] 夏术阶[1] 

机构地区：[1]上海交通大学附属上海市第一人民医院泌尿外科,200080 [2]贵州省人民医院泌尿外科

出　　处：《中华实验外科杂志》2015年第9期2194-2195,共2页Chinese Journal of Experimental Surgery

基　　金：贵州省科技厅-贵州省人民医院联合基金资助项目（黔科合LS[2012]005）;贵阳市社会发展与民生科技计划基金资助项目（筑科合同[2012103]056号）

摘　　要：目的 探讨不同切口在孤肾猪选择性肾段动脉钳夹阻断中的可行性.方法 将9头猪按照切口不同随机分成3组,每组3头：上腹部肋下横切口组、腰切口组和与腰骶肌平行切口组.所有猪先切除右肾,再选择性钳夹阻断左肾下极动脉60 min.术后24 h,取左肾行病理检查.结果 上腹部肋下横切口组手术因肾蒂血管出血或肾段动脉痉挛而失败.腰切口组和与腰骶肌平行切口组手术均成功,但腰切口组分离肾动脉下极支耗时[（9.7 ±0.8）min]比与腰骶肌平行切口组[（5.9±0.4） min]长（P＜0.05）.两组猪肾术后24h病理切片显示左肾无血供阻断的上、中极未见特殊改变,有血供阻断的肾下极广泛性肾小管变性、坏死,坏死灶周围见少量炎细胞浸润.结论 以小型猪为研究对象,利用与腰骶肌平行切口行选择性肾段动脉阻断,手术操作简便,阻断效果确实.Objective To assess the feasibility of different incision to establish a solitary-kidney porcine model of selective segmental renal artery clamping.Methods A total of 9 domestic pigs were randomized into 3 equal groups according to incision such as superior abdominal transverse incision,flank incision and incision parallel to lumbosacral muscle.Each subject underwent right radical nephrectomy to create the condition of a solitary kidney.On the left side,selective segmental renal artery clamping was performed for 60 minutes.After the reperfusion period of 24 h,the pigs were sacrificed and pathological changes in left kidney were observed.Results The operation using superior abdominal transverse incision failed because of the hemorrhage of pedicles vessels or the spasm of segmental renal artery.Using flank incision or incision parallel to lumbosacral muscle,the operation was successful to isolate and clamp the inferior branch artery.Especially,the time was longer to isolate the inferior branch artery through the lumbar incision [（9.7 ±0.8） min] than through incision parallel to lumbosacral muscle [（5.9 ±0.4） min,P ＜ 0.05].24 hours later in the cortex of lower pole,extensive tubular hydropic degeneration,coagulation necrosis and infiltration of inflammatory cells in tissue surrounding necrotic foci was observed,but no change in the glomeruli.However,no glomerular or tubular pathological change in the renal cortex of middle and upper pole was observed.Conclusion In miniature pigs,selective segmental renal artery clamping can be reliably achieved through an incision parallel to the lumbosacral muscle.

关 键 词：切口 选择性肾段动脉钳夹阻断 猪 热缺血 

分 类 号：R691.204[医药卫生—泌尿科学]