Anidjar M, Desgrandchamps F, Martin L, Cochand-Priollet B, Cussenot O, Teillac P, Le Duc A
Department of Urology, Hopital Saint-Louis, Paris, France.
J Endourol. 1996 Feb;10(1):51-6. doi: 10.1089/end.1996.10.51.
Laparoscopic suturing is still difficult and time-consuming. The aim of this study, using the porcine model, was to evaluate the feasibility, safety, and efficacy of laparoscopic fibrin glue ureteral anastomosis without stay sutures for approximating the ureteral ends. In five pigs, after bilateral cystoscopic insertion of a 7F ureteral catheter, each upper ureter was laparoscopically dissected free and transected with scissors. The ureteral ends were then approximated with two atraumatic grasping forceps, and the fibrin glue was applied over the anastomotic site using a specially designed catheter (Duplocath). After waiting 5 minutes for the sealant to adhere, the forceps were removed, and the anastomotic site was examined for any early disruption. The ureteral stents were then pulled back to the distal ureter, and retrograde ureteropyelography was accomplished bilaterally in order to assess the immediate patency of the anastomoses. The animals were sacrificed and the ureteral anastomoses surgically removed for histologic examination. The operative time after insertion of the trocars averaged 15 minutes for each anastomosis, and no early disruption was observed after withdrawal of the grasping forceps. Immediate ureteral fluoroscopic patency was achieved in all 10 ureteral anastomoses, without leakage in 8 and with minimal leakage in 2. Histologic examination revealed a mild inflammatory reaction in the serosa with no modifications of the mucosa or the muscularis. Subsequently, two pigs were subjected to the same procedure bilaterally and not sacrificed. These two animals died with enormous urinomas on postoperative days 6 and 8. In each case, the anastomotic site was completely disrupted on one side, while the other side remained grossly patent. However, histologic examination of these latter anastomoses revealed no real coaptation of the ureteral ends, while demonstrating complete eversion of the mucosa. In conclusion, fibrin glue ureteroureterostomies, although easy to accomplish, are not safe enough to be used without stay sutures in laparoscopic surgery.
腹腔镜缝合仍然困难且耗时。本研究旨在使用猪模型评估在不使用定位缝线的情况下，腹腔镜下纤维蛋白胶输尿管吻合术使输尿管断端对合的可行性、安全性和有效性。在5头猪身上，经双侧膀胱镜插入7F输尿管导管后，通过腹腔镜游离并剪断每条上输尿管。然后用两把无损伤抓钳将输尿管断端对合，使用特制导管（Duplocath）在吻合部位涂抹纤维蛋白胶。等待5分钟使密封剂黏附后，移除抓钳，并检查吻合部位有无早期破裂。然后将输尿管支架拉回输尿管远端，双侧进行逆行输尿管肾盂造影，以评估吻合口的即时通畅情况。处死动物后，手术切除输尿管吻合口进行组织学检查。每个吻合口在插入套管针后的平均手术时间为15分钟，移除抓钳后未观察到早期破裂。所有10个输尿管吻合口在输尿管荧光镜检查中即时通畅，8个无渗漏，2个有轻微渗漏。组织学检查显示浆膜有轻度炎症反应，黏膜和肌层无改变。随后，对2头猪双侧进行相同手术且未处死。这2只动物分别在术后第6天和第8天死于巨大尿囊肿。在每种情况下，一侧吻合部位完全破裂，而另一侧大体上仍通畅。然而，对这些后期吻合口的组织学检查显示输尿管断端并未真正对合，同时显示黏膜完全外翻。总之，纤维蛋白胶输尿管吻合术虽然易于完成，但在腹腔镜手术中不使用定位缝线时不够安全。
