腹腔镜腰椎手术的动物实验研究

Animal experiment of laparoscopic lumbar surgery

目的通过动物实验探讨不同方式的腹腔镜腰椎手术可行性和安全性。方法取家猪3只,分别采用腹腔镜经腹膜和后腹膜入路显露L2～S1椎间盘,比较两种入路在不同节段的优、缺点,观察两种手术的安全性和有效性。结果 3只动物均顺利的建立了腹膜后的气腹,通过腹膜后入路成功暴露了L1～L6的椎体,并切除了相应的椎间盘,手术中未见如大出血或者邻近脏器损伤的并发症,出血量平均约150 ml。3只动物的手术时间并没有随手术熟练而增加,说明腔镜手术的学习曲线陡峭及操作困难。在显露腰骶部时,经腹膜途径明显具有优势,不需要对大血管的过度牵拉;后腹膜入路进入L2～L5具有优势。结论动物实验证实腹腔镜腰椎前路的暴露及椎间盘的切除是可行的,猪可以作为模拟手术理想的动物模型。

Objective To discuss the feasibility and safety of different laparoscopic lumbar surgeries by animal experiment.Methods Three domestic pigs were selected.Their L2 to S1 intervertebral disks were exposed by the laparoscope through the approaches of peritonaeum and posterior peritonaeum.Comparison was made in the advantages and disadvantages of those two approaches at different segments.And the safety and efficacy of those two operations were evaluated.Results Retroperitoneal pneumoperitoneum was successfully established in the three porcine models.The L1-L6 vertebrae were successfully exposed through the retroperitoneal approach,and relative intervertebral disks were excised.Complications such as hemorrhage and injuries of nearby organs did not occur.The average volume of bleeding induced by the operation was about 150 ml.The operative time did not become shorter along with the technical proficiency,which explained the sharp slope of the learning curve and the operating difficulty of the laparoscopic operation.When the lumbosacral area was exposed,the peritoneal approach had significant advantage which would not excessively drag the big vessels.However,the retroperitoneal way had the advantages in the approach to L2-L5 vertebrae.Conclusion This animal experiment identifies that the exposure of the laparoscopic anterior lumbar spine and the excision of the intervertebral disk are feasible.Swine can be used as the ideal animal for the training operation.