经会阴穿刺注射玻璃酸钠扩张狄氏间隙改良前列腺根治性切除术安全性的动物实验

Safety of modified radical prostatectomy by transperineal injection of sodium hyaluronate to the Dirichlet gap:an animal experimen

目的通过动物实验组织学观察,探讨经直肠超声引导下经会阴穿刺注射玻璃酸钠扩张狄氏间隙在提升腹腔镜下前列腺根治性切除术安全性方面的价值。方法选用健康雄性纯种比格犬14只,随机分为两组,每组7只。对照组采用常规腹腔镜行根治性前列腺切除,实验组经直肠超声引导下穿刺狄氏间隙注射玻璃酸钠2.5 mL后行腹腔镜根治性前列腺切除。观察两组比格犬总手术时间、分离前列腺时间、术中出血量、直肠状态。结果经前列腺与直肠之间的狄氏间隙注射玻璃酸钠操作后,切下的前列腺中未见直肠组织,且两组后方直肠未见明显损伤。术后对照组血红蛋白(HGB)为(118.70±2.56)g/L低于实验组的(122.10±2.19)g/L(P=0.02);对照组总手术时间为(141.40±9.80)min长于实验组的(119.10±9.16)min(P<0.05);对照组分离前列腺时间为(24.99±1.75)min长于实验组的(16.64±2.34)min(P<0.05);实验组术中出血量为(34.86±5.18)mL明显低于对照组的(47.43±4.32)mL(P<0.05)。结论在动物实验中,经直肠超声引导下穿刺狄氏间隙注射玻璃酸钠2.5 mL后行腹腔镜根治性前列腺切除可缩短总手术时间、分离前列腺时间,减少出血量,可能降低了直肠损伤这一严重并发症的发生率。本研究初步确立了这一方法用于临床前列腺癌根治术的可行性。

Objective To explore the safety of transrectal ultrasound-guided transperineal injection of sodium hyaluronate to expand the Dirichlet gap in laparoscopic radical prostatectomy.Methods A total of 14 healthy male purebred beagle dogs were selected and randomly divided into 2 groups,with 7 in either group.The control group was treated with conventional laparoscopic radical prostatectomy,while the experimental group was treated with laparoscopic radical prostatectomy after 2.5 mL sodium hyaluronate was injected into the Dirichlet gap under the guidance of transrectal ultrasound.The total operation time,prostate separation time,intraoperative blood loss and rectal status of the 2 groups were observed.Results After the injection of sodium hyaluronate into the Dirichlet gap between the prostate and the rectum,no rectal tissue was found in the prostate,and no obvious damage was found in the posterior rectum in either groups.The postoperative hemoglobin(HGB)was[(118.70±2.56)g/L vs.(122.10±2.19)g/L,P=0.02];the total operation time was[(141.40±9.80)min vs.(119.10±9.16)min,P<0.05];the prostate separation time was[(24.99±1.75)min vs.(16.64±2.34)min,P<0.05];the amount of bleeding was[(47.43±4.32)mL vs.(34.86±5.18)mL,P<0.05]in the control group and experimental group.Conclusion Laparoscopic radical prostatectomy performed after 2.5 mL of sodium hyaluronate injection into the Dirichlet gap under the guidance of transrectal ultrasound can shorten the total operation time,the separation and resection time of the prostate,and reduce the amount of bleeding,which can improve and reduce the incidence of rectal injury,and prove the feasibility of this approach for prostatic cancer.