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目的:介绍构建经阴道NOTES辅助腹腔镜肾切除术猪动物模型的经验和体会,并评价其应用价值。方法:本组选择6头健康雌性小型猪,中位重量46(42～48)kg。全麻,取70°侧卧位,双后肢外展。于脐两侧缘分别置入一5mm和10mm trocar。自阴道后穹窿置入一5mm trocar。自阴道trocar置入腹腔镜,脐缘两tro-car置入操作器械。用电凝钩和吸引器锐性和钝性相结合游离肾脏,逐步显露肾蒂,用Hem-o-lock和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,扩大阴道后穹窿切口取出。结果:6例经阴道NOTES辅助腹腔镜猪肾切除术均成功完成,未中转标准腹腔镜或开放手术,亦未另增操作通道。其中左侧3例,右侧3例。中位手术时间100(70～150)min。其中建立通道中位时间10(9～22)min,肾脏切除中位时间15(7～30)min,标本取出中位时间65(40～80)min;术中中位失血量30(20～40)ml。术中无大血管及腹腔脏器损伤等严重并发症发生。结论:建立经阴道NOTES辅助腹腔镜肾切除术的动物模型可行。该模型较真实地模仿人体NOTES的操作过程,是现阶段进行学员培训和特殊器械研发较适宜的方式。
Objective: To introduce the experience and experience of constructing the animal model of transvaginal NOTES assisted laparoscopic nephrectomy and to evaluate its application value. Methods: The group of 6 healthy female miniature pigs selected, the median weight of 46 (42 ~ 48) kg. General anesthesia, take 70 ° lateral position, double hind limb abduction. On both sides of the umbilical cord were placed a 5mm and 10mm trocar. After the vaginal posterior fornix into a 5mm trocar. Laparoscopic vaginal trocar placement, umbilical cord two tro-car operation equipment. With coagulation hook and suction device sharp and blunt combined with the free kidney, and gradually revealed the renal pedicle, with Hem-o-lock and titanium clip blocking renal artery and ureter, complete removal of the kidney, into the homemade specimen bag, expand Vaginal vaginal fornix incision. Results: 6 cases of transvaginal NOTES assisted laparoscopic porcine nephrectomy were successfully completed, no standard laparoscopic or open transfer surgery, no additional access. Of which 3 cases on the left and 3 cases on the right. The median operation time 100 (70 ~ 150) min. Among them, the median time of establishing the channel was 10 (9-22) min, the median time of renal resection was 15 (7-30) min, and the median time of removal was 65 (40-80) min. 40) ml. Intraoperative no major blood vessels and abdominal organ damage and other serious complications. Conclusion: It is feasible to establish a transvaginal NOTES-assisted laparoscopic nephrectomy animal model. The model is more realistic to simulate the human body NOTES operation process, is the current stage trainee training and special equipment research and development more appropriate way.