McKay T C, Albala D M, Gehrin B E, Castelli M
Department of Urology, Loyola University Medical Center, Maywood, Illinois 60153.
J Urol. 1994 Nov;152(5 Pt 1):1637-40. doi: 10.1016/s0022-5347(17)32494-1.
Using 10 female pigs, an open ureteral resection and suture anastomosis (5 pigs) was compared to a laparoscopic resection and a fibrin glue anastomosis (5 pigs). The fibrin glue technique was performed by laparoscopically excising a ureteral segment, placing 2 transmural sutures over a stent and sealing the anastomosis with tissue adhesive, a mixture of concentrated fibrinogen and thrombin. At 4 weeks the stent was removed. At 8 weeks, the animals underwent antegrade pyelograms and Whittaker renal pelvis perfusion test and then were sacrificed. The experimental group had 1 anastomotic breakdown; all others had patent ureters. Radiographically, both groups demonstrated mild to moderate hydroureteronephrosis. Renal pelvis perfusion tests were higher in the fibrin glue group (12.6 cm. H2O versus 3.0 cm. H2O); however, all were normal for the porcine model. Histologic evaluation demonstrated increased muscular and serosal fibrosis and inflammation in the fibrin glue group when compared with the control group. Laparoscopic ureteral reanastomosis with fibrin glue is feasible; however, further research is needed to understand its full potential in urology.
使用10只雌性猪，将开放式输尿管切除并缝合吻合术（5只猪）与腹腔镜切除及纤维蛋白胶吻合术（5只猪）进行比较。纤维蛋白胶技术的操作方法是通过腹腔镜切除一段输尿管，在支架上放置2根全层缝线，并用组织粘合剂（浓缩纤维蛋白原和凝血酶的混合物）封闭吻合口。4周时取出支架。8周时，对动物进行顺行肾盂造影和惠特克肾盂灌注试验，然后处死动物。实验组有1例吻合口破裂；其他所有动物的输尿管均通畅。影像学检查显示，两组均有轻至中度肾盂积水。纤维蛋白胶组的肾盂灌注试验结果较高（12.6厘米水柱对3.0厘米水柱）；然而，对于猪模型而言，所有结果均属正常。组织学评估显示，与对照组相比，纤维蛋白胶组的肌肉和浆膜纤维化及炎症有所增加。腹腔镜下使用纤维蛋白胶进行输尿管再吻合术是可行的；然而，需要进一步研究以了解其在泌尿外科中的全部潜力。
