标准腹腔镜器械猪动物模型腹膜后经阴道纯NOTES肾切除术研究

发布时间：2018-02-26 21:26

本文关键词： 标准腹腔镜器械动物模型腹膜阴道 NOTES 切除术研究　出处：《首都医科大学》2017年博士论文　论文类型：学位论文

【摘要】：经自然孔道内镜手术(Natural Orifice Translumenal Surgery,NOTES)是指通过人体与外界自然相通的腔道如胃、结肠、阴道及膀胱等,以内镜置入体腔完成手术操作的微创治疗方法。NOTES技术包括混合NOTES(hybrid NOTES,HNOTES)及完全NOTES(pure NOTES,PNOTES)两类。与传统开放手术相比,NOTES的技术特点和优势在于无体表伤口,机体损伤小,麻醉需求量少,伤口并发症少等。目前可能的手术穿刺位点包括经胃、经口、经阴道、经直肠及经膀胱途径。经阴道途径切口操作相对简单,可在直视下完成,切口闭合容易,并发症少,是目前NOTES技术的主要手术穿刺位点。目前泌尿外科经阴道NOTES(transvaginal pure NOTES,TVPNOTES)技术大多采用经腹入路。目的:探索标准腹腔镜器械行腹膜后入路经阴道纯NOTES(TVPNOTES)肾切除的安全性和可行性。方法:1.雌猪4只,平均体重31kg,气管全麻后切开阴道后外侧壁,钝性扩张阴道内切口并分离阴道周围组织,置入自制扩张气囊初步扩张腹膜后空间,经阴道内切口安装TriPort建立操作通道,置入腹腔镜行腹膜后探查术,观察术中及术后2周并发症情况。2.雌猪6只,平均体重30kg,气管全麻后行阴道后外侧壁切开,钝性扩张阴道内切口,并分离阴道周围组织,置入自制扩张气囊初步扩张腹膜后空间,经阴道内切口安装改良型TriPort建立操作通道,置入腹腔镜后于直视下钝性、锐性结合分离腹膜后组织至肾脏平面,参照腹腔镜肾切除术切除肾脏,取出肾脏后间断缝合阴道内切口。术后2周观察生命体征及并发症情况。1.4例实验均完成了阴道切开,其中3例TriPort安装成功,并完成了腹膜后探查。置入TriPort成功的3例实验均出现了明显的切口漏气情况,无法维持有效的气腹压力,术中术后未观察到并发症。结果:2.2例实验早期出现腹膜损伤而中止手术,1例在辅助Trocar的帮助下成功切除并取出肾脏,3例成功完成标准腹腔镜器械腹膜后经阴道NOTES肾切除术,术中术后未见并发症。结论:1.标准腹腔镜器械行猪动物模型腹膜后经阴道纯NOTES肾切除术安全可行。2.改良的TriPort可作为猪模型腹膜后经阴道纯NOTES技术操作平台。
[Abstract]:Natural Orifice Translumenal Surgerynot (NOTES) refers to the natural communication between the human body and the outside world, such as stomach, colon, vagina and bladder. There are two kinds of minimally invasive treatment methods. Notes: mixed NOTES(hybrid NOTES (HNOTES) and complete NOTES(pure NOTES (PNOTES). Compared with traditional open surgery, the technical features and advantages of NOTES are that it has no surface wound, less injury and less anesthetic demand. The possible sites of surgical puncture include transgastric, transoral, transvaginal, transrectal and transvesical approaches. The transvaginal incision is relatively simple and can be completed under direct vision. The incision is easy to close and has fewer complications. At present, transvaginal NOTES(transvaginal pure NOTES (TVPNOTES) is the main operative puncture site of NOTES technique. Objective: to explore the safety and safety of retroperitoneal retroperitoneal approach for transpaginal nephrectomy with standard laparoscopic instruments. Method: 1. Four female pigs, The average body weight was 31 kg. After general trachea anesthesia, the posterior lateral wall of vagina was cut open, the inner incision of vagina was dilated passively and the perivaginal tissue was separated. The self-made dilated airbag was placed into the primary dilated retroperitoneal space, and TriPort was installed through the incision of the vagina to establish the operation channel. Retroperitoneal exploration was performed by laparoscopy. Complications during and 2 weeks after operation were observed in 6 female pigs with an average body weight of 30 kg. After general trachea anesthesia, posterior lateral vaginal wall incision, blunt expansion of the vaginal incision, and separation of perivaginal tissue were performed. The retroperitoneal space was initially dilated by self-made dilated airbags, and modified TriPort was installed through the intravaginal incision to establish the operation channel. After the placement of laparoscopy, blunt peritoneal tissue was obtuse under direct vision, and the retroperitoneal tissue was separated from the renal plane by sharp combination. With reference to laparoscopic nephrectomy, the kidney was removed and the intravaginal incision was sutured intermittently. The vital signs and complications of 1. 4 cases were observed 2 weeks after operation. Vaginal incision was completed in 3 cases, among which 3 cases were successfully installed with TriPort. The results of retroperitoneal exploration were performed in 3 cases successfully implanted with TriPort. All of them had obvious incision leakage and could not maintain effective pneumoperitoneum pressure. Results there was no postoperative complication in 2. 2 cases with peritoneal injury in the early stage of the experiment, 1 case was successfully resected with the help of Trocar and 3 cases were successfully performed retroperitoneal NOTES nephrectomy with standard laparoscopic instruments, 1 case was successfully resected with the help of Trocar, 3 cases were successfully performed retroperitoneal NOTES nephrectomy with standard laparoscopic instruments. There were no complications after operation. Conclusion\\\%\\%\\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%
【学位授予单位】：首都医科大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R699;R-332

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