经尿道单孔腔镜膀胱肿瘤整块切除术的离体动物模型实验研究  

Experimental study of en-bloc resection of bladder tumors by transurethral single-port laparoscopy in vivo animal models

作　　者：王伟峰[1] 张军 万建省[1] 刘四明 邹源 郑少秋 郝继东[1] 廖国强[1] 龚华 欧阳磊 WANG Weifeng;ZHANG Jun;WAN Jiansheng;LIU Siming;ZOU Yuan;ZHENG Shaoqiu;HAO Jidong;LIAO Guoqiang;GONG Hua;OUYANG Lei(Department of Urology,Shanghai University of Medicine&Health Sciences Affiliated Zhoupu Hospital,Shanghai 201318;Graduate School,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]上海健康医学院附属周浦医院泌尿外科,上海201318 [2]上海中医药大学研究生院,上海201203

出　　处：《现代泌尿外科杂志》2024年第2期179-182,共4页Journal of Modern Urology

基　　金：浦东新区卫生健康委员会卫生计生科研面上项目(No.PW2020A-29);浦东新区卫生健康委员会学科建设项目(No.PWZzk2022-22)。

摘　　要：目的探讨电子膀胱软镜联合腹腔镜器械经尿道协同操作实施膀胱肿瘤整块切除的可行性,为该技术的临床应用提供参考。方法自行设计加工的经尿道单孔PORT、Olympus电子膀胱软镜作为观察镜,Φ1.8 mm软性抓钳作为协助显露器械及腹腔镜操作器械(组织剪、电钩、超声刀等),以离体猪膀胱为模型,经尿道放置自制单孔PORT,置入Olympus电子膀胱软镜观察膀胱内壁全貌及黏膜情况,在膀胱腔内设定病变部位,再经电子膀胱软镜的工作通道插入软性抓钳钳夹提拉待切除黏膜,并在目标位带张力固定,保持满意的观察视野,术者左手持膀胱软镜,右手操作腹腔镜器械经PORT进入膀胱腔,在软镜监视及软性抓钳提拉协同下,模拟剪切、推拨动作,实现对病变黏膜的整块切除。结果在2个离体猪膀胱模型上成功切除了4个不同部位的病灶处黏膜。结论体外实验显示电子膀胱软镜联合腹腔镜器械实施经尿道单孔腔镜膀胱肿瘤整块切除术,在不额外增加经皮膀胱切口医源性膀胱损伤的条件下,实现了多种器械协同作用下的切除效果,该方法处理膀胱肿瘤可行,进一步优化后具有临床应用潜力。Objective To explore the feasibility of en-bloc resection of bladder tumors by flexible cystoscope combined with laparoscopic instruments through urethra and to provide reference for the clinical application of this technique.Methods Self-designed and processed transurethral single-hole PORT and Olympus electronic cystoscope were used as observation mirror;Φ1.8 mm soft grasper,tissue scissors,electric hook,and ultrasonic scalpel were used as instruments;the porcine bladder was used as a model.The PORT was placed through the urethra,and the cystoscope was inserted to observe the inner wall of the bladder and the condition of the mucosa.After the lesion site was identified in the bladder cavity,the soft grasper was inserted to pull the mucosa to be removed,which was then fixed with tension at the target position to maintain a satisfactory feild of view.The surgeon held the cystoscope in the left hand,and operated the laparoscopic instruments into the bladder cavity through the PORT with the right hand.Observing with the cystoscope and lifting and pulling the mucosa with the grasper,the surgeon simulated the cutting and pushing actions to realize the en-bloc resection of the lesioned mucosa.Results The mucosa at 4 different locations were successfully resected on 2 in vitro porcine bladder models.Conclusion The in vitro experiments show that the combination of flexible electronic cystoscope and laparoscopic instruments achieves synergistic effects in en-bloc resection of bladder tumor by transurethral single-hole laparoscope without additional iatrogenic bladder injury caused by percutaneous bladder incision.This method is feasible in the treatment of bladder tumors,and has the potential of clinical application after further optimization.

关 键 词：经尿道 膀胱软镜 软性抓钳 腹腔镜器械 膀胱肿瘤 整块切除 动物模型 体外 猪膀胱 

分 类 号：R737.14[医药卫生—肿瘤]