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目的初步尝试经腹单孔多通道末端可弯3D腹腔镜行猪肾盂输尿管成形术,评估3D单孔腹腔镜肾盂输尿管离断成形术的可行性,总结使用末端可弯3D腹腔镜的经验及操作难点。方法猪全麻后取仰卧位,向左摇床30°,取经右侧腹直肌切口,长约3 cm,逐层切开至腹腔后,置入Olympus单孔多通道系统(Quad-Port)建立操作通道。充入CO2,气腹压达14 mm Hg,置入Olympus 10 mm末端可弯3D腹腔镜及预弯器械,打开侧腹膜,沿肾盂向下游离3 cm长的输尿管,离断并上下纵行剖开1 cm。用4-0可吸收线连续缝合输尿管前壁并打结,翻转输尿管180°后连续缝合后壁。完成吻合前置入双J管,最后间断缝合3针完成缝合。结果在不增加额外通道的情况下顺利完成手术,手术时间68 min。为了实践练习单孔腹腔镜下缝合技术,共缝合猪输尿管11针,用时53 min。术中出血少,无术中并发症。结论经腹单孔多通道3D腹腔镜下肾盂输尿管成形术安全、可行,但手术操作难度较大。配合使用末端可弯3D腹腔镜及可弯、预弯器械,使得手术图像立体感强,视野更加灵活,手术操作精确度高,有效降低单孔器械“打架”及手眼协调难度。
OBJECTIVE: To evaluate the feasibility of transvaginal single-hole multi-channel endoscopic 3D laparoscopic pig’s ureteropelvic angioplasty to assess the feasibility of 3D single-hole laparoscopic ureteropelvic pyeloplasty and summarize the experience and operation of end-bendable 3D laparoscopy difficulty. Methods After general anesthesia, pigs were supine and shaked 30 ° to the left. The right rectus abdominis muscle incision was made. The length of the rectum was about 3 cm. The layers were dissected into the abdominal cavity and placed into the Olympus single-hole multi-channel system (Quad- Establish operation channel. CO2, pneumoperitoneum pressure 14 mm Hg, into the Olympus 10 mm end of the bend 3D laparoscopic and pre-bending instruments, open the side of the peritoneum, the pelvis downstream free 3 cm long ureter, off and up and down longitudinal section Open 1 cm. With 4-0 absorbable line continuous suture ureter anterior wall and knot, flip ureter 180 ° continuous suture the posterior wall. Into the double J before the completion of anastomosis, the last interrupted suture 3 needle to complete the suture. Results The operation was completed successfully without adding additional channels. The operation time was 68 min. In order to practice single hole laparoscopic suture technique, a total of 11 pigs ureter suture, with the time 53 min. Less bleeding, no intraoperative complications. Conclusion Transabdominal single hole multi-channel 3D laparoscopic ureteropelvic ureteroplasty is safe and feasible, but the operation is more difficult. With the use of flexible 3D endoscopic laparoscopic and bend, pre-curved instrument, making the surgical image three-dimensional sense of more flexible field of vision, surgical operation and high accuracy, effectively reducing the single-hole device “fight ” and hand-eye coordination difficulty.