山羊腹腔镜脾脏切除术及其对机体生理机能的影响
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摘要
腹腔镜手术与开腹手术相比具有手术视野清晰、出血量少、微创、对机体影响小、疼痛反应轻和术后恢复快等特点，已经广泛的应用于人类医学。在兽医领域国外早就有腹腔镜技术在动物中应用的报道，并且涉及到的动物种属、应用领域广泛。然而国内腹腔镜技术在动物领域中的应用还仅仅局限于繁殖领域，其它方面的应用还未见报道。
山羊脾脏切除可用于许多学科的实验研究以及教学、临床病例治疗等。对科学研究来说，山羊摘除脾脏后，机体抗体产生减少，抵抗力降低，易于病毒、细菌和某些寄生虫感染，因此，为人工造病提供易感动物。对临床病例治疗而言，脾脏切除术的适应症为脾肿瘤、脾脓肿、损伤性脾破裂以及某些血液疾病等。
本实验分两部分：一部分是通过腹腔镜进行山羊右肷部、左肷部和腹中线腹腔镜探查获得腹腔镜下腹腔解剖资料。为诊断和治疗山羊腹腔内疾病及其必要的手术操作提供重要的解剖资料。
另一部分是山羊腹腔镜脾脏切除术。在腹腔探查的基础上确定套管锥／套管的定位，从山羊左腹部进入四个套管，气腹压维持在1.064kPa，由术者操纵单极电凝钩和腹腔镜抓钳，在腹腔镜的监视下分离脾脏，充分暴露脾门后用钛夹和丝线结扎脾动、静脉，剪断脾动、静脉，脾脏完全游离后装入标本袋，拿出体外。在整个手术过程中用重症监护仪和呼吸监护仪进行全过程监护，并在术前、麻醉后—气腹前、术中10min、术中30min和放气后5min记录数据，术后观察山羊整体状态和术后一个月用腹腔镜探查腹腔内粘连情况，评价腹腔镜脾脏切除术和腹腔镜技术在山羊外科手术方面应用的可行性。结果表明：
1．腹腔镜腹腔探查能非常清楚的观察到腹腔内脏器和腹腔内整体情况，并且明显减少腹腔并发症。表明相对于山羊的开腹探查术来说，山羊腹腔镜腹腔探查术是一个安全、有效和值得推广的方法，本实验获得了实验山羊腹腔镜下腹腔部分器官及其相对位置的重要解剖资料。
2．腹腔镜脾脏切除术后腹腔粘连率为11％，表明腹腔镜手术能降低术后腹腔内粘连程度。
3．腹腔镜脾脏切除手术使山羊血压、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。表明虽然山羊腹腔镜脾脏切除术与非腹腔镜脾脏切除术相比对山羊循环和呼吸系统影响小，但是对山羊的循环和呼吸系统还是有一定的影响，在腹腔镜手术过程中应该加强监护。
4．本实验中9只山羊均成功的完成了腹腔镜脾脏切除术。手术平均时间大约70min左右(52～88min)，手术切口总长4～6cm，是开腹脾脏切除术切口的1／3～1／2。所有山羊术后当天进食少量青草，表现出中等程度的腹痛症状，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，每只山羊术后都观察一个月，没有发现异常状况。表明腹腔镜技术能成功的应用于山羊腹腔镜外科手术，并且具有对山羊机体损伤小、痛苦轻、术后恢复快的优点。
Laparoscopic surgery has been widely used in human medicine, because compared withlaparotomy it has a clear vision, the less bleeding, minimal incision, relatively little impact on thebody, mild pain and rapid recovery features. Application of laparoscopic techniques has long beenreported in animals in veterinary field abroad and involved a wide range of animal species andapplication fields. However, application of laparoscopic techniques in animal fields only wasconfined to breeding fields in china and has not been reported in other fields.
Splenectomy in goats can be used for study of many disciplines and teaching, clinicaltreatment. For Science and research, After goats was removed spleen, the body produced antibodiesto reduce, resistance was reduced and easy to be infected by viruses, bacteria and some parasitic.Therefore, it can provide susceptible animals for artificial disease. Fortreatment of clinical cases,the indication for splenectomy is splenic tumors, splenic abscess, spleen injury and some blooddiseases.
The experiment was divided into two parts: One was that it acquired laparoscopic abdominalanatomy data through laparoscopy of left flank, right flank and ventral median line. It can provideimportant anatomy for the diagnosis and treatment of intra-abdominal diseases and necessarysurgical operation of goats.
Another part was laparoscopic splenectomy. The location of trocar/cannula was definited onthe basis of laparoscopy and four cannula was inserted from left flank. Maintainedpneumoperitoneum pressure at 1.064kPa. Surgeon manipulated monopolar electrosurgical hookand laparoscopic forceps to isolated spleen under the laparoscopy. Ligated artery, vein of spleenwith clip and silk suture after fully exposed hilum of spleen and then cut it. Placed spleen into‘Extraction Bag' and then removed it out of abdominal cavity. It was monitored during theoperation with intensive care monitor and respiratory monitor and were recorded at the time ofbefore anesthesia, after anesthesia and before insuffiating, intraoperative 10min and 30min, 5minafter gas was released. Overall state of goats was observated after operation and was exploredabdominal adhesions at postoperative a month. The laparoscopic splenectomy and the feasibility ofthe application of laparoscopic surgery were evaluated in goats. The results showed:
1. It could be observe very clearly the overall situation of intra-abdominal organs andabdominal cavity and significantly reduce the complications. Showed that compared withlaparotomy in goats, laparoscopy could be safe, efficient and useful methods.
2. Rate of postoperative adhesions of laparoscopic splenectomy was 11 percent. Showed thatlaparoscopic surgery could reduce the degree of postoperative adhesions.
3. Blood pressure, heart rate, respiratory rate and end-tidal carbon dioxide partial pressure ofgoats increased and oxygen saturation and temperature dropped during laparoscopic splenectomy.Showed that, to a certain extent, laparoscopic splenectomy affected circulatory system, respiratorysystem and temperature. We should strengthen monitoring during laparoscopic operation.
4. Nine goats were successfully performed laparoscopic splenectomy in this study. The totallength of incision was 4～6cm. It was one-third to one-second of incision of laparotomy. All goatsate a small amount of grass and showed symptoms of abdominal pain after operation. However, thefollowing day showed a good mental state, normal appetite and temperature, basically returned tonormal body condition. Each goat was observed for a month, it is no abnormal situation. Showedthat laparoscopic techniques can be successfully applied to laparoscopic surgery in goats, and has aadvantage of little influence on the body, mild pain and rapid recovery.
山羊脾脏切除可用于许多学科的实验研究以及教学、临床病例治疗等。对科学研究来说，山羊摘除脾脏后，机体抗体产生减少，抵抗力降低，易于病毒、细菌和某些寄生虫感染，因此，为人工造病提供易感动物。对临床病例治疗而言，脾脏切除术的适应症为脾肿瘤、脾脓肿、损伤性脾破裂以及某些血液疾病等。
本实验分两部分：一部分是通过腹腔镜进行山羊右肷部、左肷部和腹中线腹腔镜探查获得腹腔镜下腹腔解剖资料。为诊断和治疗山羊腹腔内疾病及其必要的手术操作提供重要的解剖资料。
另一部分是山羊腹腔镜脾脏切除术。在腹腔探查的基础上确定套管锥／套管的定位，从山羊左腹部进入四个套管，气腹压维持在1.064kPa，由术者操纵单极电凝钩和腹腔镜抓钳，在腹腔镜的监视下分离脾脏，充分暴露脾门后用钛夹和丝线结扎脾动、静脉，剪断脾动、静脉，脾脏完全游离后装入标本袋，拿出体外。在整个手术过程中用重症监护仪和呼吸监护仪进行全过程监护，并在术前、麻醉后—气腹前、术中10min、术中30min和放气后5min记录数据，术后观察山羊整体状态和术后一个月用腹腔镜探查腹腔内粘连情况，评价腹腔镜脾脏切除术和腹腔镜技术在山羊外科手术方面应用的可行性。结果表明：
1．腹腔镜腹腔探查能非常清楚的观察到腹腔内脏器和腹腔内整体情况，并且明显减少腹腔并发症。表明相对于山羊的开腹探查术来说，山羊腹腔镜腹腔探查术是一个安全、有效和值得推广的方法，本实验获得了实验山羊腹腔镜下腹腔部分器官及其相对位置的重要解剖资料。
2．腹腔镜脾脏切除术后腹腔粘连率为11％，表明腹腔镜手术能降低术后腹腔内粘连程度。
3．腹腔镜脾脏切除手术使山羊血压、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。表明虽然山羊腹腔镜脾脏切除术与非腹腔镜脾脏切除术相比对山羊循环和呼吸系统影响小，但是对山羊的循环和呼吸系统还是有一定的影响，在腹腔镜手术过程中应该加强监护。
4．本实验中9只山羊均成功的完成了腹腔镜脾脏切除术。手术平均时间大约70min左右(52～88min)，手术切口总长4～6cm，是开腹脾脏切除术切口的1／3～1／2。所有山羊术后当天进食少量青草，表现出中等程度的腹痛症状，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，每只山羊术后都观察一个月，没有发现异常状况。表明腹腔镜技术能成功的应用于山羊腹腔镜外科手术，并且具有对山羊机体损伤小、痛苦轻、术后恢复快的优点。
Laparoscopic surgery has been widely used in human medicine, because compared withlaparotomy it has a clear vision, the less bleeding, minimal incision, relatively little impact on thebody, mild pain and rapid recovery features. Application of laparoscopic techniques has long beenreported in animals in veterinary field abroad and involved a wide range of animal species andapplication fields. However, application of laparoscopic techniques in animal fields only wasconfined to breeding fields in china and has not been reported in other fields.
Splenectomy in goats can be used for study of many disciplines and teaching, clinicaltreatment. For Science and research, After goats was removed spleen, the body produced antibodiesto reduce, resistance was reduced and easy to be infected by viruses, bacteria and some parasitic.Therefore, it can provide susceptible animals for artificial disease. Fortreatment of clinical cases,the indication for splenectomy is splenic tumors, splenic abscess, spleen injury and some blooddiseases.
The experiment was divided into two parts: One was that it acquired laparoscopic abdominalanatomy data through laparoscopy of left flank, right flank and ventral median line. It can provideimportant anatomy for the diagnosis and treatment of intra-abdominal diseases and necessarysurgical operation of goats.
Another part was laparoscopic splenectomy. The location of trocar/cannula was definited onthe basis of laparoscopy and four cannula was inserted from left flank. Maintainedpneumoperitoneum pressure at 1.064kPa. Surgeon manipulated monopolar electrosurgical hookand laparoscopic forceps to isolated spleen under the laparoscopy. Ligated artery, vein of spleenwith clip and silk suture after fully exposed hilum of spleen and then cut it. Placed spleen into‘Extraction Bag' and then removed it out of abdominal cavity. It was monitored during theoperation with intensive care monitor and respiratory monitor and were recorded at the time ofbefore anesthesia, after anesthesia and before insuffiating, intraoperative 10min and 30min, 5minafter gas was released. Overall state of goats was observated after operation and was exploredabdominal adhesions at postoperative a month. The laparoscopic splenectomy and the feasibility ofthe application of laparoscopic surgery were evaluated in goats. The results showed:
1. It could be observe very clearly the overall situation of intra-abdominal organs andabdominal cavity and significantly reduce the complications. Showed that compared withlaparotomy in goats, laparoscopy could be safe, efficient and useful methods.
2. Rate of postoperative adhesions of laparoscopic splenectomy was 11 percent. Showed thatlaparoscopic surgery could reduce the degree of postoperative adhesions.
3. Blood pressure, heart rate, respiratory rate and end-tidal carbon dioxide partial pressure ofgoats increased and oxygen saturation and temperature dropped during laparoscopic splenectomy.Showed that, to a certain extent, laparoscopic splenectomy affected circulatory system, respiratorysystem and temperature. We should strengthen monitoring during laparoscopic operation.
4. Nine goats were successfully performed laparoscopic splenectomy in this study. The totallength of incision was 4～6cm. It was one-third to one-second of incision of laparotomy. All goatsate a small amount of grass and showed symptoms of abdominal pain after operation. However, thefollowing day showed a good mental state, normal appetite and temperature, basically returned tonormal body condition. Each goat was observed for a month, it is no abnormal situation. Showedthat laparoscopic techniques can be successfully applied to laparoscopic surgery in goats, and has aadvantage of little influence on the body, mild pain and rapid recovery.
引文
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