犬气腹与非气腹腹腔镜卵巢子宫切除术的研究
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摘要
腹腔镜技术作为微创外科的主体部分,已经广泛的应用于人类医学。在国外,该技术已经应用到兽医临床诊疗和外科手术中。而在国内的应用还仅局限于繁殖领域。有关腹腔镜手术的基础理论研究不断深入,气腹引发的并发症逐渐受到人们的重视,非气腹腹腔镜技术在兽医临床也有重要的价值。
卵巢子宫切除术是兽医外科实践较为常见的手术之一,可以用于预防和治疗乳腺癌、子宫积脓等疾病,也是绝育的一种方法。传统的卵巢子宫切除术是通过正中腹白线切口切除卵巢和子宫,双重结扎后剪断卵巢和子宫的附着点,三层闭合腹壁。但手术引发的并发症较多。腹腔镜卵巢子宫切除术在国外兽医临床中应用较早,是比较成熟的手术之一。迄今,国内还没有关于犬腹腔镜卵巢子宫切除术的报道。
本实验将10只犬随机分成两组,分别进行二氧化碳气腹腹腔镜卵巢子宫切除术(LOVH)和非气腹卵巢子宫切除术(GOVH)。LOVH采用“三孔法”完成,气腹压维持在1.33kPa。GOVH采用矩形腹壁扩张法。由术者操纵双极电凝钳和腹腔镜抓钳,在腹腔镜的监视下凝断卵巢悬吊韧带,卵巢茎,子宫阔韧带,子宫动脉,子宫颈;使用丝线套扎子宫颈;将游离的卵巢子宫装入标本袋,拿出体外。在手术过程中用重症监护仪和呼吸监护仪进行全程监护,并在术前、麻醉后、术中10min、30min、50min及术后5min记录数据,比较手术对机体循环和呼吸系统的影响。在术前、术后、术后1d、3d、5d,采集静脉血,进行白细胞计数,测定血清中C-反应蛋白和白细胞介素-6的含量,比较手术对机体应激的影响。术后观察并记录犬整体状态,术后10d用腹腔镜探查腹腔内情况,检查术后情况,评价手术的安全性、可行性和实用性。结果表明:
1.试验中的10只犬全部成功完成了卵巢子宫切除术,LOVH手术平均时间是50min(45-75min),GOVH平均时间是60min(50-82min)。所有犬术后当天进食少量食物,阴道出现间断性的出血。但是术后第二天精神状态良好,食欲和体温正常,基本恢复到正常体况。表明LOVH和GOVH对机体机能的影响都很小,手术后能迅速恢复。腹腔镜卵巢子宫切除术是一种安全、有效的手术方法,有在小动物临床诊疗中应用的价值。
2. LOVH对机体呼吸和循环系统的影响较GOVH大。由于LOVH中充二氧化碳气腹,使犬血压、心率、呼吸频率和呼吸末二氧化碳分压升高,血氧饱和度和体温下降。因此,在手术过程中应该加强监护。
3. GOVH对机体应激的影响较LOVH大。由于手术过程中,使用简单的矩形腹壁扩张方法,在提来腹壁的过程中棉布条摩擦腹膜及切口,对机体的损伤较LOVH大。而且腹壁扩张形成的空间不够稳定,对手术造成了一定的困难,延长了手术时间。
As the major part of minimally invasive surgery, laparoscopic surgery has been widely used in human medicine.Internationally the laparoscopic technique has been applied in veterinary clinical diagnosis,therapy and surgery. However, domestic laparoscopic technique applying on animal field is very limited and most of which were used for breeding areas. With the development of basic theory on laparoscopic surgery, the complication of aeroperitoneum was concerned. Gasless laparoscopic surgery also has important value in veterinary practice.
Ovariohysterectomy (OVH), the most common surgical procedure performed in veterinary practice, prevents or treat mammary cancer and pyometra .OVH is the method of choice for sterilization in the dog. Traditional OVH involves surgical removal of the ovaries and uterus through a median celiotomy.The points of attachment of the uterus and ovaries are double ligated and transected, and the abdomen is typically closed in 3 layers. But, the complications can occur. There were many reports in veterinary field abroad about laparoscopic ovariohysterectomy. Laparoscopic ovariohysterectomy is one of comparative perfect operation. There are no report about veterinary laparoscopic surgery in dogs in China now.
Ten female dogs were randomly assigned to two groups, carried out gaseous laparoscopic ovariohysterectomy (LOVH) and gasless laparoscopic ovariohysterectomy(GOVH). LOVH was performed by three portal sites method, maintained intra-abdominal pressure of 1.33kPa. GOVH was performed by expanding abdominal wall rectangularly. Surgeon manipulated bipolar coagulation and laparoscopic grasping forceps to disrupted the suspensory ligament, ovarian pedicle, the broad ligament, arteria uterine and cervix under the laparoscopy. Then, looped ligature the stump of cervix. Ovaries and uterus were placed into‘Extraction Bag’and then removed from abdominal cavity. It was monitored during the operation with intensive care monitor and respiratory monitor and were recorded at the time of before anesthesia, after anesthesia, intraoperative 10min , 30min and 50min, 5min after operation.The effect on cirulatory system and respiratory system were compared. White blood cell were recorded. Blood samples for measurement of C-reactive protein and interleukin-6 concentrations were collected at the time of preoperatively, postoperative immediately, and 1, 3, 5 days postoperatively. The effect on stress were compared. Overall state of dogs was observated after operation and was explored abdominal adhesions at postoperative ten days. The security and feasibility of the application of laparoscopic ovariohysterectomy were evaluated in dogs. The results showed:
1. Ten dogs were successfully performed laparoscopic ovariohysterectomy in this study. A median of 50 minutes (range, 45-75 minutes) was needed to complete the LOVH, but GOVH needed 60min(range, 50-82min). All dogs ate a small amount of food and showed symptoms of abdominal pain after operation. However, the following day showed a good mental state, normal appetite and temperature, basically returned to normal body condition. Showed the effect on animal is mild, it can be recover quickly. Laparoscopic ovariohysterectomy is a safety and available approach. It can be successfully completed in dogs.
2. Compared with GOVH, LOVH resulted in a higher effect on cirulatory system and respiratory system. Because of using carbon dioxide, blood pressure, heart rate, respiratory rate and end-tidal carbon dioxide partial pressure of dogs increased and oxygen saturation and temperature dropped during laparoscopic ovariohysterectomy. We should strengthen monitoring during laparoscopic operation.
3. Compared with LOVH, GOVH resulted in a higher effect on stress. Because of using sample method to expand abdominal wall, cotton strip rubed peritoneum and incision to lead to a certain damage during GOVH. And the space was not stabilize enough. Thus,the operation of GOVH is more difficult than LOVH, the operation time is longer.
卵巢子宫切除术是兽医外科实践较为常见的手术之一,可以用于预防和治疗乳腺癌、子宫积脓等疾病,也是绝育的一种方法。传统的卵巢子宫切除术是通过正中腹白线切口切除卵巢和子宫,双重结扎后剪断卵巢和子宫的附着点,三层闭合腹壁。但手术引发的并发症较多。腹腔镜卵巢子宫切除术在国外兽医临床中应用较早,是比较成熟的手术之一。迄今,国内还没有关于犬腹腔镜卵巢子宫切除术的报道。
本实验将10只犬随机分成两组,分别进行二氧化碳气腹腹腔镜卵巢子宫切除术(LOVH)和非气腹卵巢子宫切除术(GOVH)。LOVH采用“三孔法”完成,气腹压维持在1.33kPa。GOVH采用矩形腹壁扩张法。由术者操纵双极电凝钳和腹腔镜抓钳,在腹腔镜的监视下凝断卵巢悬吊韧带,卵巢茎,子宫阔韧带,子宫动脉,子宫颈;使用丝线套扎子宫颈;将游离的卵巢子宫装入标本袋,拿出体外。在手术过程中用重症监护仪和呼吸监护仪进行全程监护,并在术前、麻醉后、术中10min、30min、50min及术后5min记录数据,比较手术对机体循环和呼吸系统的影响。在术前、术后、术后1d、3d、5d,采集静脉血,进行白细胞计数,测定血清中C-反应蛋白和白细胞介素-6的含量,比较手术对机体应激的影响。术后观察并记录犬整体状态,术后10d用腹腔镜探查腹腔内情况,检查术后情况,评价手术的安全性、可行性和实用性。结果表明:
1.试验中的10只犬全部成功完成了卵巢子宫切除术,LOVH手术平均时间是50min(45-75min),GOVH平均时间是60min(50-82min)。所有犬术后当天进食少量食物,阴道出现间断性的出血。但是术后第二天精神状态良好,食欲和体温正常,基本恢复到正常体况。表明LOVH和GOVH对机体机能的影响都很小,手术后能迅速恢复。腹腔镜卵巢子宫切除术是一种安全、有效的手术方法,有在小动物临床诊疗中应用的价值。
2. LOVH对机体呼吸和循环系统的影响较GOVH大。由于LOVH中充二氧化碳气腹,使犬血压、心率、呼吸频率和呼吸末二氧化碳分压升高,血氧饱和度和体温下降。因此,在手术过程中应该加强监护。
3. GOVH对机体应激的影响较LOVH大。由于手术过程中,使用简单的矩形腹壁扩张方法,在提来腹壁的过程中棉布条摩擦腹膜及切口,对机体的损伤较LOVH大。而且腹壁扩张形成的空间不够稳定,对手术造成了一定的困难,延长了手术时间。
As the major part of minimally invasive surgery, laparoscopic surgery has been widely used in human medicine.Internationally the laparoscopic technique has been applied in veterinary clinical diagnosis,therapy and surgery. However, domestic laparoscopic technique applying on animal field is very limited and most of which were used for breeding areas. With the development of basic theory on laparoscopic surgery, the complication of aeroperitoneum was concerned. Gasless laparoscopic surgery also has important value in veterinary practice.
Ovariohysterectomy (OVH), the most common surgical procedure performed in veterinary practice, prevents or treat mammary cancer and pyometra .OVH is the method of choice for sterilization in the dog. Traditional OVH involves surgical removal of the ovaries and uterus through a median celiotomy.The points of attachment of the uterus and ovaries are double ligated and transected, and the abdomen is typically closed in 3 layers. But, the complications can occur. There were many reports in veterinary field abroad about laparoscopic ovariohysterectomy. Laparoscopic ovariohysterectomy is one of comparative perfect operation. There are no report about veterinary laparoscopic surgery in dogs in China now.
Ten female dogs were randomly assigned to two groups, carried out gaseous laparoscopic ovariohysterectomy (LOVH) and gasless laparoscopic ovariohysterectomy(GOVH). LOVH was performed by three portal sites method, maintained intra-abdominal pressure of 1.33kPa. GOVH was performed by expanding abdominal wall rectangularly. Surgeon manipulated bipolar coagulation and laparoscopic grasping forceps to disrupted the suspensory ligament, ovarian pedicle, the broad ligament, arteria uterine and cervix under the laparoscopy. Then, looped ligature the stump of cervix. Ovaries and uterus were placed into‘Extraction Bag’and then removed from abdominal cavity. It was monitored during the operation with intensive care monitor and respiratory monitor and were recorded at the time of before anesthesia, after anesthesia, intraoperative 10min , 30min and 50min, 5min after operation.The effect on cirulatory system and respiratory system were compared. White blood cell were recorded. Blood samples for measurement of C-reactive protein and interleukin-6 concentrations were collected at the time of preoperatively, postoperative immediately, and 1, 3, 5 days postoperatively. The effect on stress were compared. Overall state of dogs was observated after operation and was explored abdominal adhesions at postoperative ten days. The security and feasibility of the application of laparoscopic ovariohysterectomy were evaluated in dogs. The results showed:
1. Ten dogs were successfully performed laparoscopic ovariohysterectomy in this study. A median of 50 minutes (range, 45-75 minutes) was needed to complete the LOVH, but GOVH needed 60min(range, 50-82min). All dogs ate a small amount of food and showed symptoms of abdominal pain after operation. However, the following day showed a good mental state, normal appetite and temperature, basically returned to normal body condition. Showed the effect on animal is mild, it can be recover quickly. Laparoscopic ovariohysterectomy is a safety and available approach. It can be successfully completed in dogs.
2. Compared with GOVH, LOVH resulted in a higher effect on cirulatory system and respiratory system. Because of using carbon dioxide, blood pressure, heart rate, respiratory rate and end-tidal carbon dioxide partial pressure of dogs increased and oxygen saturation and temperature dropped during laparoscopic ovariohysterectomy. We should strengthen monitoring during laparoscopic operation.
3. Compared with LOVH, GOVH resulted in a higher effect on stress. Because of using sample method to expand abdominal wall, cotton strip rubed peritoneum and incision to lead to a certain damage during GOVH. And the space was not stabilize enough. Thus,the operation of GOVH is more difficult than LOVH, the operation time is longer.
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