微创外科在颈廓清术中应用临床前评价.docVIP

微创外科在颈廓清术中应用临床前评价 　 作者：易慧明 况光仪 白殿卿 许晨耘 赵质彬 魏欣 龚选举 符志龙 【摘要】 目的 于动物实验中探讨微创外科在颈廓清手术中应用的可行性。方法 选取12只免疫后的健康成年土狗，以3%戊巴比妥钠(30mg/kg)施行静脉麻醉，其中6只取颈侧中部30mm长的模型切口，游离颈皮肌皮瓣后，用两把常规小拉钩拉开皮瓣，置入0°内镜4mm鼻窦内镜为照明光源，在直视或电视介导下用常规外科器械实施改良根治性颈廓清术加颌下腺、甲状腺和半边甲状软骨板切除手术；另外6只取颈侧100mm长斜行切口实施改良根治性颈廓清术加颌下腺、甲状腺和半边甲状软骨板切除手术。结果 (1)小切口组术中耗时(100±20)min，术中出血量为(50±30)ml，实验狗术后(2±0.5)天自由进食并自由活动，术后(7±1)天伤口愈合拆线，术后(10±2)天基本恢复术前体重。(2)大切口组术中耗时(80±20)min，术中出血量为(30±20)ml，实验狗术后(3±0.5)天自由进食并自由活动，术后(8±1)天伤口愈合拆线，术后(13±4)天基本恢复术前体重。所有实验狗术后无伤口感染、皮下积液、明显消瘦、死亡等并发症出现。结论 在电视内镜介导下用常规外科器械通过一个微小切口即可实施狗颈廓清术而达到微创外科目的，此微创颈廓清技术值得进一步在临床试用。 【关键词】 微创外科 颈廓清术 临床前评价 Preclinical evaluation of application of minimally invasive surgery in radical neck dissection 【Abstract】 Objective To evaluate the application of minimally invasive surgery(MIS)in radical neck dissection using dog as a preclinical model.Methods Twelve immunized health adult mongrel dogs were chosen.Anesthesia was maintained with 3% pentobarbital sodium by I.V. Six of the dogs were taken a 30mm horizontal skin incision in the middle area of lateral neck.After musculus cutaneous colli (MCC) were divided，two small conventional retractors were inserted to retract the strap muscles and a 0.4mm sinus endoscope was inserted as light source.Modified radical neck dissection plus excision of submandibular salivary，thyroid lobe and half-thyroid cartilage was performed with conventional instruments on direct visual or by video-assisted.The other six dogs were taken a 100mm oblique lateral neck incision，and modified radical neck dissection plus excision of submandibular salivary，thyroid lobe and half-thyroid cartilage was performed with conventional instruments.Results In group of small incision，the operation time was (100±20)minutes.The operative bleeding volume was (50±30)ml.These dogs resumed normal food/water intaken and activity (2±0.5)days after the operation.Wound healing was completed (7±1)days later.The weight was recovered as before (10±2)days later.In group of big incisio