自制新型套管用于经膀胱自然腔道内镜手术的实验研究

Novel transvesical port for NOTES procedure： an animal study

目的观察一种自制套管用于经膀胱途径的自然腔道内镜手术（NOTES）的效果。方法结合经皮肾镜穿刺技术和腹腔镜套管的结构原理，利用Solidwork三维制图软件设计新型经膀胱NOTES手术套管。在器械厂商的协助下制成样品，使用香猪动物模型完成经膀胱途径腹腔探查术、肾脏活检术、经膀胱和经胃联合途径肾脏切除术、肾部分切除术。术毕进行问卷调查，以评估该套管的各项指标。结果共完成10次动物实验，经膀胱通道均顺利建立，平均所需时间为5．6min。对套管置人便利性、套管气密性、器械置入便利性的评分均达到4分以上；而器械可选择范围和标本取出便利性的评分较低，分别为3-25分和1-75分。结论这种经膀胱NOTES专用套管能够很好地用于手术操作通道的建立。除因解剖因素导致器械选择范围和标本取出受限之外．其他各项指标均得到术者的认可，值得进一步改进和推广。

Objective To evaluate the application of a novel transvescial port for natural orifice transluminal endoscopic surgery （NOTES） procedure in porcine model. Methods A novel transvesical port with outside sheath and inner introducer was designed by using Solidwork software. Transvesical NOTES procedures of peritoneoscopy, renal biopsy, nephrectomy and partial nephrectomy were performed with the home-made port in porcine model From Aug 2009 to Nov 2010. Results Ten transvesi- cal NOTES procedures were performed successfully. The mean time for establishing the transvescial access was 5.6 rain without any complication. The scores of the new port were 4.75 （placement of the port ）, 5 （ the tightness ） and 4.25 （ insertion of the in- struments） respectively. The scores about the select range of the instruments and the specimen removal were relatively low, 3.25 and 1.75. Two further improvements including the balloon port and additional channel for urine drainage were suggested by surgeons participating in the testing. Conclusion The novel port may be useful for transvesical NOTES procedure and need to be improved in the future.