Huang Sheng-Hsien, Chiu Allen W, Lin Chia-Hsing, Liu Catherine J, Huan Steven K, Lee Bao-Sin, Lin Win-Long, Wu Sheng-Tan, Vijayan R, Lin Zin-Nai
Division of Urology, Department of Surgery, Chi Mei Foundation Medical Center, Yung-Kang City, Tainan, Taiwan.
Int Surg. 2003 Oct-Dec;88(4):199-204.
The purpose of this study was to evaluate the efficacy and long-term tissue effects of ultrasonic dissector and cyanoacrylate glue during laparoscopic partial nephrectomy in a porcine model. Nine domestic pigs underwent laparoscopic left lower pole partial nephrectomy without vascular control. An ultrasonic tissue dissector was used to assist in the parenchymal incision, and the raw surfaces of the kidneys, including the exposed urinary system, were sealed with cyanoacrylate glue. No internal stents or additional sutures were placed. Intraoperative hemorrhages and urinary extravasation were recorded. The animals were humanely killed 28 days after undergoing the operations. The long-term effects of ultrasonic dissector and cyanoacrylate glue on the healing process of urothelium and renal parenchyma were determined histologically. All pigs survived the laparoscopic partial nephrectomy, and the blood loss ranged from 0 to 120 ml (mean, 60 ml). The average operative time was 89 +/- 10 min. The severity of the bleeding was minimal in six animals and moderate in three animals. No urinary extravasation was found using intravenous urography at the 28th postoperative day. No urinary fistula or renal abscess formation was found histologically. Cyanoacrylate glue infiltrated into the tissue defects and did not dissolve. The glue was encased by fibrotic tissue with minimal foreign body inflammatory reaction. Ultrasonic dissector was effective in achieving hemostasis during laparoscopic partial nephrectomy without the need of vascular control in pigs. Cyanoacrylate glue achieved good long-term adhesive power. The sealing effects provided by cyanoacrylate glue were adequate to prevent urinary extravasation from urothelial defects at least for 1 month.
本研究的目的是在猪模型中评估超声切割器和氰基丙烯酸酯胶水在腹腔镜下肾部分切除术中的疗效及长期组织效应。9头家猪接受了未进行血管控制的腹腔镜左肾下极部分切除术。使用超声组织切割器辅助进行实质切开，肾脏的创面，包括暴露的泌尿系统，均用氰基丙烯酸酯胶水封闭。未放置内部支架或额外缝线。记录术中出血和尿外渗情况。术后28天对动物实施安乐死。通过组织学方法确定超声切割器和氰基丙烯酸酯胶水对尿路上皮和肾实质愈合过程的长期影响。所有猪均在腹腔镜下肾部分切除术后存活，失血量为0至120毫升（平均60毫升）。平均手术时间为89±10分钟。6只动物出血程度轻微，3只动物出血程度中等。术后第28天静脉肾盂造影未发现尿外渗。组织学检查未发现尿瘘或肾脓肿形成。氰基丙烯酸酯胶水渗入组织缺损处且未溶解。胶水被纤维组织包裹，异物炎症反应轻微。超声切割器在猪腹腔镜下肾部分切除术中无需控制血管即可有效止血。氰基丙烯酸酯胶水具有良好的长期黏附力。氰基丙烯酸酯胶水提供的封闭效果足以防止尿路上皮缺损处尿外渗至少1个月。
