目的 建立模拟膀胱尿道单针连续吻合法训练的动物模型.方法 体质量30 kg左右的巴马小型猪20只,速眠新10 mg/kg诱导麻醉,3.5%戊巴比妥钠0.25 g/kg术中维持.取仰卧位经脐点穿刺导入CO2制备气腹,放置3个工作套管.游离出尿道蒂,取末端小肠作为代膀胱.按照腹腔镜下膀胱尿道单针连续吻合法步骤完成吻合.6名具有腹腔镜体外模拟训练经验的学员参加培训,根据手术时间评估学员的学习曲线.结果 6名学员在该模型上均成功完成腹腔镜下膀胱尿道单针连续吻合法的各项操作技术.每只模型猪可行3次手术,学员平均接受10次膀胱尿道单针连续吻合法训练,平均手术时间第1次(55.5±10.4)min,第10次(22.4±4.8)min,2次手术时间比较差异有统计学意义(P<0.01).结论 小猪模型末端小肠替代膀胱,反复利用游离尿道蒂可提供多次训练机会,能够使学员尽快掌握腹腔镜下膀胱尿道单针连续吻合法的操作技术.
Objective To develop and evaluate a porcine model for training the single needle running suture method of laparoscopie urethrovesical anastomosis(LUA). Methods Twenty minipigs with mean weight of 30kg were general anaesthetized with Sumianxin solution 0. 1 ml/kg intramuscularly. Pneumoperitoneum was created by insufflation of carbon dioxide by a veress needle inserted through the umbilicus. One 10mm port and two 5mm ports were positioned after the establishment of pneumoperitoneum. The intestine was used as "bladder". The procedures were completed with the single needle running suture method of laparoscopic urethrovesical anastomosis. Six trainees performed the LUA procedure based on the models during a laparoscopic training course, following the technique used in the operation room. The learning curve was analyzed by operative time. Results The porcine model for laparoscopic training was established successfully and 3 LUAs could be performed on each pig. Each trainee performed 10 LUAs based on the models during the training course of laparoscopic urology. The operative time declined from (55.3±10. 4)min initially to (22.4±4.8)min (P<0. 01) after the training course. At the end of training, all trainees could accomplish a watertight LUR procedure on the model. Conclusions The establishment of the training model is feasible. The trainees could acquire the skills necessary to perform LUA in vivo based on this model. The model provides a platform for training the basic techniques of LUA procedures.