经阴道网格插入在牛模型中
1Centrum for Surgical Technologies, Department of Development and Regeneration,Clinical Specialties Research Groups, Faculty of Medicine, KU Leuven, 2Institute for the Care of Mother and Child and Third Faculty of Medicine,Charles University, Prague, 3Pelvic Floor Unit,University Hospitals KU Leuven
Summary
该方案描述了使用单一阴道切口技术在羊直肠阴道隔膜中进行网状植入，有无套管针引导插入锚固臂。
Abstract
该方案描述了使用单一的阴道切口技术将丝网插入到绵羊的直肠阴道隔膜中，在有和没有针刺引导下插入锚固臂。可汗绵羊进行直肠阴道隔膜的解剖，然后插入有或没有四个锚定臂的植入物，两者设计成适合羊的解剖结构。使用套管针和“外在”技术将锚固臂放置在适当位置。颅臂通过闭孔器，小腿肌和内收肌肌肉。尾部臂固定在骶骨韧带附近，通过尾骨肌肉。这种技术允许模仿在患有盆腔器官脱垂的妇女中进行的外科手术。解剖空间和元素容易识别。手术最关键的部分是插入颅内套管针，可以很容易地穿透腹膜腔或周围的盆腔器官。氏可以通过更广泛的腹膜后解剖和更多侧向引导套管针来避免。这种方法仅用于大型动物模型中的新型植入物的实验测试，因为临床上目前没有使用针灸引导插入。
Introduction
盆腔器官脱垂在一半以上的妇女临床诊断，至少有一名阴道分娩，但从主观上讲，其中一半的女性整体感染1例 。治疗的主要是使用任一天然组织或植入材料手术重建，但每一种方法都有其局限性，包括复发或局部并发症2，3，4。理想的植入物尚未确定;因此，在向市场推出新产品和技术之前，对产品创新的持续需求以及开发临床前实验的适当管道。一个在此轨道中的步骤是在合适的动物模型5实验评估，6。理想情况下，它们应该模仿解剖，生物力学和生物环境。当谈到th对新型植入物的实验评估，通常在较小的模型中首先测试，用于生物相容性或重建腹壁缺陷。这种类型的实验受到批评，因为植入物没有插入感兴趣的区域（ 即阴道） 7 。阴道手术模型更为稀缺，当实验的目标是记录外植体的生物力学特征时，肯定是这样。因此，有一只兔从兔子移到了羊8 。成年母羊是大型动物模型，具有相当大小和可及的阴道。它们可被用于新的植入物的中期评估，并且能够再现阴道暴露与某些材料9，10，11，12，13。不仅尺寸和解剖学的阴道和盆底与人类相当，但也发生在发生在15％的母羊中的脱垂的自发性发生。脱出的危险因素是重叠的（ 即，multiparity，POP的既往史，增加更高的体重引起的腹内压或丘陵，且（植物）的雌激素效果可比放牧时）6，14。在欧洲，羊是唯一合理的选择，因为对非人灵长类动物的研究几乎完全被禁止。在这里，通过模拟使用套管针和导向器的植入物的经阴道插入，将网格进一步放置到正阴 – 阴道隔膜中，进一步模型。这之后，通过固定用带通过肌肉的韧带，其可以被认为等同于临床实践15,16臂锚定植入物。到目前为止，这种技术虽然许多人认为由于使用这些较长的条和/或解剖结构的刺穿可能会发生特定的并发症。
在早期详细的解剖学研究中，将卵巢盆底与女性骨盆17进行了比较。当涉及到植入物的锚固时，羊不具有骶棘状韧带，但它们确实具有非常发达和广泛的骶骨韧带。阴部神经在其上方运行，使得这个地标作为悬浮点不安全。相反，尾骨肌及其筋膜以及闭孔膜可通过直肠阴道空间进入。这里提出了用于固定锚固臂的解剖结构的进入和位置。讨论了可用于定位网格的仪器。最后，武器或套管针对相邻解剖结构（如血管和神经）的关系，a也有潜在的术中并发症。
Protocol
该实验的伦理批准是从鲁汶大学动物实验伦理委员会（P065 / 2013）获得的。根据现行国家动物福利准则处理动物。 材料与实验动物 手术准备 在外科手术室中覆盖一张无菌悬垂的桌子，并准备一个无菌弯曲的套管针（ 图1 ， 图 A），无菌手术器械，缝合线和无菌纱布。如果实验包括随访，则在无菌条件下进行整个外科手术。将所有仪器放在?…
Representative Results
管理在更长的观察设置 在外科手术之后，可以插入阴道包装（在手术后立即插入阴道中的盐水溶液浸泡的纱布包装）24小时以固定植入物位置。羊应该放在恢复笼中，其呼吸功能直到完全恢复。后来，它可以放置在稳定的羊，并允许其自由移动和喝酒， 自由进食 。阴道包装，如果存在，必须在手术后24小?…
Discussion
在这里，我们描述了羊的实验过程，旨在模拟具有或不具有锚固臂的植入物的阴道解剖和经阴道网插入。后续的步骤和仪器通过POP和压力性尿失禁15，16，19，20进行的外科手术的启发。在初步的解剖学解剖之后，在实验中插入网孔时仍然存在一些问题。在第一只动物中，发现了一个穿孔在腹腔内的脱?…
Divulgazioni
The authors have nothing to disclose.
Acknowledgements
感谢Ivan Laermans，Rosita Kinart，Ann Lissens（外科技术中心，比利时鲁汶KU Leuven）。 Jo Verbinnen和Kristof Reyniers（比利时鲁汶KU Leuven医学院Vesalius解剖学研究所）在实验过程中提供了技术支持。感谢Leen Mortier对数据和手稿管理的帮助。我们感谢FEG Textiltechniken制造原型网格，对其进行消毒，并无条件捐赠给研究机构。
Materials
| Animals: | |||
| parous female sheep (45 – 65 kg) | Zoötechnical Institute of the KU Leuven | NA | experimetnal animal |
| Sterile clothing: | |||
| sterile drape 45 x 75 cm | Lohmann & Rauscher, Regensdorf, Germany | 33002 | other material |
| sterile OR drape 150 x 180 cm | Lohmann & Rauscher, Regensdorf, Germany | 33009 | other material |
| sterile glowes 2x | Lohmann & Rauscher, Regensdorf, Germany | 16652 | other material |
| sterile surgical gown 2x | Lohmann & Rauscher, Regensdorf, Germany | 19342 | other material |
| surgical head cap 2x | Lohmann & Rauscher, Regensdorf, Germany | 17427 | other material |
| surgical face mask 2x | Lohmann & Rauscher, Regensdorf, Germany | 11983 | other material |
| Other surgical material | |||
| implant | FEG Textiltechnik GmbH, Aachen, Germany | NA | purposely designed implant |
| 3/0 polypropylene suture | Prolene, Ethicon, Diegem, Belgium | 8762H | suture material |
| 3/0 polygecaprone suture | Vicryl, Ethicon | J311H | suture material |
| gauze swabs 10 x 10 cm 10x, 12-ply | Lohmann & Rauscher, Regensdorf, Germany | 11574 | other material |
| syringe 20 mL | Becton Dickinsosn S.A., Madrid, Spain | 300613 | aqua-dissection |
| needle 16 gauge | Terumo, Leuven, Belgium | NN-2238R | aqua-dissection |
| Surgical equipment: | |||
| blade no.22 | Fine science isntruments, Heidelberg, Germany | 10022-00 | surgical instruments |
| Allis tissue forceps 1x | Fine science isntruments, Heidelberg, Germany | 11091-15 | surgical instruments |
| Standart pattern forceps 1×2 theeth 1x | Fine science isntruments, Heidelberg, Germany | 11023-14 | surgical instruments |
| Standart pattern forceps straight serrated 1x | Fine science isntruments, Heidelberg, Germany | 11000-14 | surgical instruments |
| Scalpel handle 1x | Fine science isntruments, Heidelberg, Germany | 10004-13 | surgical instruments |
| Halstead-Mosquito forceps 2x | Fine science isntruments, Heidelberg, Germany | 13008-12 | surgical instruments |
| Standart pattern scissors 1x | Fine science isntruments, Heidelberg, Germany | 14001-14 | surgical instruments |
| Metzenbaum scissors 1x | Fine science isntruments, Heidelberg, Germany | 14016-18 | surgical instruments |
| Crile Wood needle holder 1x | Fine science isntruments, Heidelberg, Germany | 12003-15 | surgical instruments |
| Kell forceps 1x | Fine science isntruments, Heidelberg, Germany | 13018-14 | surgical instruments |
| Long Starr Self-Retaining Retractor with eight 5mm sharp stay hooks | Cooper Surgical, Tumbull, USA | 3704 | surgical instruments |
| Heaney Simon Vaginal Retractor | Medical supplies & equipments co., Katy, Texas, USA | 403-129FSI | surgical instruments |
| Trocar (Insnare) | Bard, West Sussex, United Kingdom | NA | any trocar on market for transvaginal mesh implantation |
| Medication: | |||
| amoxilicilline clavulanate 1000mg / 300 mL (Ampiciline) | GSK, Wavre, Belgium | NA | antibiotics |
| buprenorfin 0.3 mg/mL + chlorocresol 1.35 mg/mL (Vetregesic) | Ecuphar, Oostkamp, Belgium | NA | analgesia |
| ketamin HCL 100mg/mL (Ketamine 1000) | Ceva Sante Animale, Brussels, Belgium | NA | anesthesia |
| isoflurane (IsoFlo) | Abbott Laboratories Ltd, Maidenhead, Berkshire, UK | NA | anesthesia |
| polyvidone iodium 7.5% (Braunol) | B. Braun Medical, Machelen, Belgium | NA | local desinfection |
| saline solution 500ml | B. Braun Medical, Machelen, Belgium | NA | aqua-dissection |
| Xxylazine HCl , 1 mL/50 kg | Vexylan, Ceva Sante Animale, Belgium | NA | premedication |
| atropine Sulfate 15 mg/ml (), | Viatris, Belgium | NA | premedication |
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Citazione di questo articolo
Urbankova, I., Callewaert, G., Sindhwani, N., Turri, A., Hympanova, L., Feola, A., Deprest, J. Transvaginal Mesh Insertion in the Ovine Model. J. Vis. Exp. (125), e55706, doi:10.3791/55706 (2017).