经阴道单纯内镜阑尾切除术的实验研究

Transvaginal appendectomy by endoscopy in canine models

目的探讨在动物模型上完成经阴道单纯内镜阑尾切除术的安全性及可行性。方法用6条体质量12-15妇的雌性杂种犬，行经阴道单纯内镜阑尾切除术。将实验犬右侧卧位，经阴道后穹窿置入治疗内镜，应用钛夹夹闭阑尾动脉，热活检钳及针状刀游离阑尾，尼龙圈套扎及圈套器电凝电切阑尾，切除阑尾标本由阴道取出，阴道切口用钛夹及尼龙圈关闭。实验动物术后2h开始进食，饲养2周后处死解剖。结果6例手术均成功完成，手术时间48～158min，平均（94．2±41．8）min，术中出血1例，直肠灼伤1例。术后饲养2周，均生长良好，未见明显并发症。尸检见手术创面及阴道切口愈合良好。结论经阴道内镜阑尾切除术安全可行。但要过渡到临床尚需要内镜配件的不断改进。

Objective To evaluate the technical feasibility and safety of transvaginal appendectomy by endoscopy in canine models. Methods Six female dogs weighing between 12-15 kg underwent transvaginal appendectomy by endoscopy. A small incision at posterior fornix of the vagina was made endoscopically by a needle knife and then dilated by a balloon dilator. After the endoscope entered the peritoneal cavity, the appendicular artery was clipped and the appendix was dissociated, and then the free appendix was ligated by an endoloop near root and removed by snare cutting. The appendix was then removed through the vaginal port. Fi- nally, the vaginal incision was closed by clipping and endolooping. Two weeks after the procedure, the animals were sacrificed for anatomic investigation. Results Endoscopic transvaginal appendectomy was successfully performed in all animals with a mean operating time of （94. 2 ±41.8） min. Complicated bleeding occurred in 1 dog and rectal burn in another during the operation. All the experimental animals survived the post operative period for 2 weeks without any complications. Post mortem examination revealed that the wound and vaginal incision healed well. Conclusion Transvaginal appendectomy by endoscopy is safe and feasible in a canine model, while further study and progression of appropriate accessories are needed for future clinical use.