CAJ | 학술논문

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42～48 kg,中位质量46 kg.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5 mm和10 mm套管,距齿状线上方约2 cm处置入5 mm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90～180 min,中位时间120 min;术中失血量20～50 ml,中位失血量40 ml.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.
목적 평개경직장자연강도내경수술(NOTES)보조복강경하신절제술저동물모형적응용개치. 방법 건강자성보통저6지,질량42～48 kg,중위질량46 kg.행경직장NOTES보조복강경하신절제술,좌측3례,우측3례.전마.취70°측와위,쌍후지외전고정.우제량측연분별치입5 mm화10 mm투관,거치상선상방약2 cm처치입5 mm투관.자직장투관치입복강경,제연량투관치입조작기계.용전응구화흡인기예성화둔성결합행신장유리,축보현로신체,용Hem-o-lok혹태협조단신동、정맥급수뇨관,완정절제신장,장입자제표본대,확대직장절구후취출. 결과 본조6례수술균성공완성,미중전보통복강경혹개방수술,미신증조작통도.수술시간90～180 min,중위시간120 min;술중실혈량20～50 ml,중위실혈량40 ml.술중무대혈관급복강장기손상등엄중병발증발생. 결론 성공건립경직장NOTES보조복강경하신절제술적동물모형,제시경직장도경가성위NOTES입로적신선택.
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-mm 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 trocar at the margin of umbilicus.Dissection was performed using conventional laparoscopic instruments placed through the abdominal trocars under direct vision achieved by the 5-mm flexible-tip 0o laparoscope placed through the rectal trocar.Renal artery,vein,and ureter were dissected and clamped by Hem-o-lok 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)ml.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.