Name: vessel-sparing excision and primary anastomosis
Uploaded: 2019-01-07T14:00:00
Description: Watch this Scientific Journal Video about Vessel-sparing Excision and Primary Anastomosis at JoVE.com

作者没有任何承认。

所有患者均提供了经签署的书面知情同意书, 并获得了当地道德委员会 (ec/201/0438) 的批准。
请注意:所提出的议定书的纳入标准是: 男性;年龄≥ 18岁;签署书面知情同意书;适合操作;孤立的尿道狭窄;尿道狭窄≤3厘米;尿道狭窄仅在球囊或膜状部位。排除标准是: 女性;变性者;年龄 & lt;18 years;未签署书面知情同意书;不适合操作;& gt;1 concomitant urethral strictures;尿道狭窄 & gt;...

<ol>
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E., Mundy, A. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Non-transecting+bulbar+urethroplasty.">Non-transecting bulbar urethroplasty.</a> Translational Andrology and Urology. 4 (1), 41-50 (2015).</li><li>Anderson, K. M., Blakely, S. A., O'Donnell, C. I., Nikolavsky, D., Flynn, B. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Primary+non-transecting+bulbar+urethroplasty+long-term+success+rates+are+similar+to+transecting+urethroplasty.">Primary non-transecting bulbar urethroplasty long-term success rates are similar to transecting urethroplasty.</a> International Urology and Nephrology. 49 (1), 83-88 (2017).</li><li>Summerton, D. J., Kitrey, N. 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G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=SIU/ICUD+Consultation+on+Urethral+Strictures:+Pelvic+Fracture+Urethral+Injuries.">SIU/ICUD Consultation on Urethral Strictures: Pelvic Fracture Urethral Injuries.</a> Urology. 83 (3), S48-S58 (2014).</li><li>Le, W., Li, C., Zhang, J., Wu, D., Liu, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Preliminary+clinical+study+on+non-transecting+anastomotic+bulbomembranous+urethroplasty.">Preliminary clinical study on non-transecting anastomotic bulbomembranous urethroplasty.</a> Frontiers in Medicine. 11 (2), 277-283 (2017).</li><li>Gomez, R. G., Campos, R. A., Velarde, L. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reconstruction+of+Pelvic+Fracture+Urethral+Injuries+With+Sparing+of+the+Bulbar+Arteries.">Reconstruction of Pelvic Fracture Urethral Injuries With Sparing of the Bulbar Arteries.</a> Urology. 88, 207-212 (2016).</li><li>Eswara, J. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Refinement+and+validation+of+the+urethral+stricture+score+in+categorizing+anterior+urethral+stricture+complexity.">Refinement and validation of the urethral stricture score in categorizing anterior urethral stricture complexity.</a> Urology. 85 (2), 474-477 (2015).</li><li>Dindo, D., Demartines, N., Clavien, P. -. 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2010年, 根特大学医院初步进行了除血管切除和原发吻合术的尿道狭窄修复术。此后, 它成为医院管理孤立的短球体或后尿道狭窄患者的实践标准。由于球茎仍然附着在会阴体上, 进入后尿道和切除该部位的纤维化组织可能会受到损害。骨盆骨折导致的拉米扭曲可能会进一步阻碍获得治疗。如果是这种情况, 由于访问不便而无法完成完全切除, 则会做出手术后的决定, 以进行与球囊动脉结扎和球茎脱离...

尿道成形术被认为是尿道狭窄的标准治疗方法, 因为它提供了出色的长期成功率1,2。大量的手术技术已经被描述, 挑战重建泌尿科医生选择最佳的方法, 考虑到各种严格的方式, 如限制的数量, 狭窄的长度, 狭窄的位置,病因、合群和以前的尿道干预。对于孤立的短球状尿道狭窄, 国际泌尿系统疾病咨询 (icud) 建议尿道成形术切除和原发性吻合 (epa) 与综合成功率为 93.8 3,4。
epa 的尿道成形术体现了一种方法, 即整个尿道病变段被切除, 取而代之的是健康的相邻尿道, 而不需要移植或皮瓣来弥合缝隙。传统上, 这种方法包括在狭窄5的水平上的海绵体的全厚度分割。然而, 由于 epa 只需要切除狭窄的部分和周围的海绵体纤维化, 海绵体的全厚度分割, 以及其中的双尿道血液供应, 通常是不必要的。在这一背景下, 约旦等人在2007年提出了船只省力办法的想法, 为传统的横截面环保局 (tepa)6、7提供了一种非横切的替代办法。自那时以来, 这个节省船只的 epa (vsepa) 一直在兴起, 几个中心--尽管稍作修改--在他们的手术曲目8、9、10、11 中实施了这一技术,12岁。
该技术旨在减少手术创伤, 特别是在海绵体中嵌入的尿道的双动脉供血。球囊动脉的保存有可能降低术后勃起功能障碍或缺血的风险。此外, 它可能是有益的后续尿道干预, 如使用游离移植重做尿道成形术, 其中一个良好的血管移植床是必不可少的8,9。然而, 这些潜在的好处只是假设, 因为目前缺乏前瞻性研究, 将这两种技术的功能结果与经过验证的调查问卷进行比较。
尽管功能结果很重要, 但 vsepa 至少应该能够提供与 tepa 相似的手术结果。有希望的短期结果已经公布, 并符合 icud 报告的成功率, 但迄今为止, 尚未对这两种技术进行直接比较, 3、4、8、9 10,11,12。
盆腔骨折相关的尿道损伤与瘢痕组织的形成和随后的尿道狭窄或完全闭塞的膜尿道有关。手术后或对前列腺13的照射后, 后路狭窄也可能发生。对于这些狭窄, 尿道成形术与疤痕组织的切除和球茎前列腺吻合术被推荐以及14。传统上, 球状动脉结扎在此过程中, 如果没有因为骨盆骨折已经被抹杀。为了避免这种情况, 引入并报告了一个节省船只的变种以及15,16。
本文的目的是给一个详细的, 一步一步的概述如何管理患者孤立的短球杆或后尿道狭窄与 vsepa。主要范围是概述和可视化的手术技术, 并报告具有代表性的手术结果。功能结果参数的评价超出了本文的范围。

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	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">iso-Betadine Dermicum 125 ml (1)</td>
			<td style="width:183px;">Meda Pharma</td>
			<td style="width:149px;">A-472825</td>
			<td style="width:159px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:299px;">Sterile gown (3)</td>
			<td style="width:183px;">According to surgeon&#39;s preference</td>
			<td style="width:149px;">NA</td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:299px;">Sterile gloves (3 pairs)</td>
			<td style="width:183px;">According to surgeon&#39;s preference</td>
			<td style="width:149px;">NA</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">Sterile drapes (4)</td>
			<td style="width:183px;">Medline</td>
			<td style="width:149px;">AGBBA073A</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">Bard-Parker scalpel number 3 (1)</td>
			<td style="width:183px;">Zepf Medical Instruments</td>
			<td style="width:149px;">06-1003-00</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">Bard-Parker scalpel number 4 (1)</td>
			<td style="width:183px;">KLS Martin Group</td>
			<td style="width:149px;">10-100-04</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">Scalpel blade number 15 (1)</td>
			<td style="width:183px;">Swann-Morton</td>
			<td style="width:149px;">0205</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">Scalpel blade number 24 (1)</td>
			<td style="width:183px;">Swann-Morton</td>
			<td style="width:149px;">0211</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">Surgical forceps 14 cm (2)</td>
			<td style="width:183px;">KLS Martin Group</td>
			<td style="width:149px;">12-301-14</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">Monopolar electrocauter Valleylab&#160; (1)</td>
			<td style="width:183px;">Medtronic</td>
			<td style="width:149px;">E2100</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">Electrocauter blade 15 cm (1)</td>
			<td style="width:183px;">Comepa</td>
			<td style="width:149px;">CO 150i</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">Debakey forceps 20 cm (2)</td>
			<td style="width:183px;">D&#252;fner</td>
			<td style="width:149px;">06232-20</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">3-layered compress 30 x 45 cm (5)</td>
			<td style="width:183px;">M&#246;lnlycke Health Care</td>
			<td style="width:149px;">175260</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">Surgical compress 10 x 10 cm (10)</td>
			<td style="width:183px;">Hartmann</td>
			<td style="width:149px;">232088</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">Mayo-Hegar needle driver 18 cm (1)</td>
			<td style="width:183px;">Zepf Medical Instruments</td>
			<td style="width:149px;">24-1804-18</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">Mayo-Hegar needle driver 25 cm (1)</td>
			<td style="width:183px;">Zepf Medical Instruments</td>
			<td style="width:149px;">24-1804-25</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">Jones scissor 18 cm (1)</td>
			<td style="width:183px;">D&#252;fner</td>
			<td style="width:149px;">04940-18</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">Mayo-Stille scissor 17 cm (1)</td>
			<td style="width:183px;">Zepf Medical Instruments</td>
			<td style="width:149px;">08-1700-17</td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;">Lone Star retractor (1)</td>
			<td style="width:183px;">CooperSurgical, Trumbull, CT, USA</td>
			<td style="width:149px;">72403867</td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:299px;">Lone Star elastic stays (4)</td>
			<td style="width:183px;">CooperSurgical, Trumbull, CT, USA</td>
			<td style="width:149px;">3311-1G</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">Vessel loop 45 cm (1)</td>
			<td style="width:183px;">Braun</td>
			<td style="width:149px;">1095137</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">Halsted-Mosquito (6)</td>
			<td style="width:183px;">KLS Martin Group</td>
			<td style="width:149px;">13-317-21</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">20Fr silicone urethral catheter (1)</td>
			<td style="width:183px;">Yushin Medical Co.</td>
			<td style="width:149px;">1037B-20</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">3Fr ureteral catheter (1)</td>
			<td style="width:183px;">Teleflex</td>
			<td style="width:149px;">223602</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">20Fr metal sound (1)</td>
			<td style="width:183px;">Custom made</td>
			<td style="width:149px;">NA</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">Vicryl 4-0 wire (6)</td>
			<td style="width:183px;">Ethicon</td>
			<td style="width:149px;">V734D</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">Vicryl 3-0 wire (2)</td>
			<td style="width:183px;">Ethicon</td>
			<td style="width:149px;">VCP316H</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">Vicryl Rapide 3-0&#160; wire (1)</td>
			<td style="width:183px;">Ethicon</td>
			<td style="width:149px;">VF2260</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">10Fr Drain needle (1)</td>
			<td style="width:183px;">Vygon</td>
			<td style="width:149px;">658.10</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">10Fr Suction drain (1)</td>
			<td style="width:183px;">Oriplast</td>
			<td style="width:149px;">203102</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">Vacuum flask 400 ml (1)</td>
			<td style="width:183px;">Oriplast</td>
			<td style="width:149px;">213215AL/QL</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:299px;">Zetuvit 10 x 20 cm (1)</td>
			<td style="width:183px;">Hartmann</td>
			<td style="width:149px;">413771</td>
			<td></td>
		</tr>
	</tbody>
</table>

vessel-sparing excision and primary anastomosis

尿道成形术被认为是尿道狭窄的标准治疗方法, 因为它提供了极好的长期成功率。对于孤立的短骨或后尿道狭窄, 建议通过切除和原发吻合术 (epa) 尿道成形术。由于 epa 只要求切除狭窄的部分和周围的海绵体纤维化, 一个全厚度的横截面海绵体, 在传统的横切 epa (tepa) 进行, 通常是没有必要的。约旦等人在2007年提出了一个保留血管的方法的想法, 旨在减少手术创伤, 特别是尿道的双动脉供血, 从而有可能降低术后勃起功能障碍或静脉缺血的风险。这种方法也可以是有益的后续尿道干预, 如使用游离移植重做尿道成形术, 其中一个良好的血管移植床是必不可少的。然而, 这些潜在的好处只是假设, 因为目前缺乏前瞻性研究, 将这两种技术的功能结果与经过验证的调查问卷进行比较。此外, 保血管 epa (vsepa) 至少应该能够提供类似于 tepa 的手术结果。本文的目的是给一个详细的, 一步一步的概述如何管理患者孤立的短球杆或后尿道狭窄与 vsepa。本手稿的主要目的是概述手术技术, 并报告具有代表性的手术结果。共有117名患者按照所述程序进行了管理。对整个患者群和球囊 (n = 91) 和后 (n = 26) vsepa 组分别进行了分析。球囊和后 vsepa 的成功率分别为93.4 和98.5%。总之, vsepa, 如协议中所述, 提供了良好的成功率, 低并发症率孤立的短球囊和后尿道狭窄。

2011年至2017年期间, 共有117例孤立的短球 (n = 91) 或后 (n = 26) 尿道狭窄患者在根特大学医院接受了 vsepa 治疗。基线特征显示在表 1中。球囊和后部狭窄的中位随访分别为35个月和45个月。接受后 vsepa 的患者的狭窄时间较长, 因此, 这一组中计算 u 分为5的患者数量较高, 为17.与球状 vsepa 组相比, 后部狭窄主要是创伤性的 (57.7%), 而球状 ...

Watch this Scientific Journal Video about Vessel-sparing Excision and Primary Anastomosis at JoVE.com

Vessel-sparing Excision and Primary Anastomosis

血管保留切除术与原发性吻合术

在这里, 我们提出了一个精心制作和有效的方案, 以治疗孤立的短球茎或后尿道狭窄与血管保留切除和原发性吻合。

Urethroplasty is considered to be the standard treatment for urethral strictures since it provides excellent long-term success rates. For isolated short ...

这种血管切除技术旨在通过切除和原发性腺切除术来减少尿道成形术期间的手术创伤。保存球状动脉可以降低术后勃起功能障碍和青花缺血的风险。此外，它可以有利于进一步尿道干预需要良好的持续血管化。在通过逆行和/或前行尿道造影确认存在严格后，在手术台上调整患者，在经过修饰的利托手术位置，膝盖和臀部弯曲60至90度，45度诱拐，小腿支撑在腿部持有人。用碘基防腐剂磨砂消毒暴露的内膜和外生殖器，并在手术场周围放置无菌窗帘，包括阴囊和阴囊，无需防癌。要进入球茎尿道，使用24号手术刀刀片做一个中线副笔皮肤切口，并通过Coles Fascia用单极电化解剖亚皮肤脂肪组织，直到球茎肌肉遇到，烧灼任何出血血管。。将球状血管瘤肌肉放在中线，并使用琼斯剪刀解剖远离底层骨骼的肌肉。然后，用四个丝绸2-0保持缝合固定球茎血管肌在内皮。应用一个自我保留的缩回器，并附上弹性保持钩到球状血管肌肉有足够的牵引力，固定弹性到缩回器的插槽之一。接下来，以圆周方式解剖球茎尿道，从中球菌区域开始，以便进一步对尿道进行回转解剖，并分离出从科波拉洞穴的图尼卡阿尔布吉内纳分离的回转。用容器环包围外露的球状尿道，用科彻夹固定环，以方便操作。使用锋利的剪刀继续在向五角的半方向进行后体解剖和分离，并密切跟随巴克筋膜的血管手术平面。然后继续对泌尿生源的静脉解剖，而不解剖肛门侧的球茎，使球状动脉在机智中。要打开严格，引入20法国硅胶尿道导管，或20法国金属声音到肉尿道尿道，并传递给尿道严格。在此级别，使用数字24手术刀刀片以纵向方式打开尿道，并在打开的尿道的每一侧放置一个丝绸3-0保持缝合，以方便尿道流明的暴露。插入三个法国尿道导管通过尿道，并近在上通过硬化区，打开沿导管的严格，直到遇到健康尿道组织。向膀胱引入 20 个法国金属声音，以评估近端尿道的质度和口径，并在打开的近近尿道的每一侧放置一根丝 3-0 保持缝合线。然后重新检查严格，以及周围的海绵纤维化，直到健康的海绵体遇到通风，并抓住尿道粘膜与一个大抓地力的脱贝钳。完全修复尿道严格和周围的尿道纤维化非常重要，以获得两个血管化良好的尿道末端。使用中断的 4-0 缝合线，将近端和远端尿道的腹端从尿道流明内部切开，以创建心室尿道板。将健康的尿道边缘溅到约一厘米，并去除留缝合线。然后使用中断的 4-0 缝合线横向关闭尿道末端的后缘，并在尿道上关闭语料库。为了防止尿道成形术失败，在没有任何张力的情况下完成动脉瘤至关重要。取出缩回器，用蛋黄酱仍然剪刀切割留缝合线。然后，用10根法国排水针打穿右内区域的皮肤。将硅胶导管留在位，在语料库和球状血管肌肉之间放置一个 10 个法国吸气管。使用 3- 0 运行缝合线关闭球茎血管肌肉在底层尿道和语料库的血管。然后，缝合科尔斯筋膜在运行的方式，并缝合皮肤与中断多纳蒂缝合，都使用3-0缝合。使用丝绸2-0缝合固定腹股沟的吸气口。然后，应用副体压缩敷料。2011年至2017年，根特大学医院共对117例孤立的短球菌或后尿道严格治疗患者进行血管切除和原发性腺切除术治疗，球茎和后体严格治疗的中位随从时间分别为35个月和45个月。两组并发症率同样低，主要包括低级事件，如伤口脱皮、伤口感染、泌尿感染、膀胱痉挛和血肿。总体看，一、二、五年球状血管切除组和原发性性肺病组的无故障存活率估计为95.3%和87%，后血管切除和原发性肺病组的存活率为88.3%。总之，血管切除和原发性性腺虫病为分离、短球菌和后尿道严格性提供了极佳的成功率和低并发症率。

Research

JoVE Journal

Medicine

The C-seal: A Biofragmentable Drain Protecting the Stapled Colorectal Anastomosis from Leakage

C密封：一个Biofragmentable漏漏电保护吻合结直肠吻合

Colorectal anastomotic leakage (AL) is a serious complication in colorectal surgery leading to high morbidity and mortality rates1. The incidence of AL ...

科研

医学

Adult Mouse Venous Hypertension Model: Common Carotid Artery to External Jugular Vein Anastomosis.

成年小鼠静脉高压型号：颈总动脉，以颈外静脉吻合。

The understanding of the pathophysiology of brain arteriovenous malformations and arteriovenous fistulas has improved thanks to animal models. A rat model ...

Primary Culture of Human Vestibular Schwannomas

人体前庭神经鞘瘤的原代培养

Vestibular schwannomas (VSs) represent Schwann cell (SC) tumors of the vestibular nerve, compromising 10% of all intracranial neoplasms. VSs occur in ...

Murine Ileocolic Bowel Resection with Primary Anastomosis

鼠回结肠肠管切除原发性吻合

Intestinal resections are frequently required for treatment of diseases involving the gastrointestinal tract, with Crohn&#8217;s disease and colon cancer ...

Isolation and Excision of Murine Aorta; A Versatile Technique in the Study of Cardiovascular Disease

隔离和小鼠主动脉切除;心血管疾病研究的一个多功能的技术

Cardiovascular disease is a broad term describing disease of the heart and/or blood vessels. The main blood vessel supplying the body with oxygenated ...

Localization, Identification, and Excision of Murine Adipose Depots

本地化识别，切除脂肪小鼠油库，并

Obesity has increased dramatically in the last few decades and affects over one third of the adult US population. The economic effect of obesity in 2005 ...

A Rat Model of Orthotopic Liver Transplantation Using a Novel Magnetic Anastomosis Technique for Suprahepatic Vena Cava Reconstruction

应用新型磁吻合技术 Suprahepatic 腔静脉重建大鼠原位肝移植模型的研究

The rat model of orthotopic liver transplantation (OLT) is essential for transplant research. It is a very sophisticated animal model and requires a steep ...

Application of End-to-end Anastomosis in Robotic Central Pancreatectomy

端到端吻合技术在机器人中心胰腺中的应用

Central pancreatectomy is carried out for the treatment of benign or low-malignant potential tumors located in the pancreatic neck or proximal part of ...

Creation of Colonic Anastomosis in Mice

小鼠结肠吻合术的建立

Intestinal anastomoses are commonly performed in both elective and emergent operations. Even so, anastomotic leaks are a highly feared complications of ...

One-anastomosis Gastric Bypass (OAGB) in Rats

One-anastomosis Gastric Bypass OAGB in Rats

大鼠胃旁路 (oagb) 的一次吻合

The goal of this protocol is to set up a preclinical model of bariatric surgery and, more specifically, OAGB in obese rats. Based on this preclinical ...