Acucise endopyelotomy in a porcine model: procedure standardization and analysis of safety and immediate efficacy.
Acucise endopyelotomy in a porcine model: procedure standardization and analysis of safety and immediate efficacy.
复制标题
猪模型中的精确肾盂内切开术：程序标准化以及安全性和即时疗效分析。
DOI：
10.1590/s1677-55382004000100013
复制
发表时间：
2004
期刊：
影响因子：
--
通讯作者：
R. Clayman
中科院分区：
文献类型：
--
作者：
C. Andreoni;M. Srougi;V. Ortiz;R. Clayman
目的
本研究旨在使用标准化技术测试Acucise器械的技术可靠性和即时疗效。
材料和方法
56例Acucise手术由一名外科医生使用标准化技术在猪中进行：将5 F血管造影导管双侧插入中输尿管，进行逆行肾盂造影，将Amplatz超硬导丝推进至肾盂水平，取出血管造影导管，将Acucise导管球囊推进至肾盂输尿管连接处（UPJ）水平，取出超硬导丝，抽吸肾盂中的造影剂并用蒸馏水替换，在75瓦纯切割电流下激活Acucise，保持球囊完全膨胀10分钟，进行逆行输尿管肾盂造影以记录外渗，取出Acucise导管，通过输尿管支架并取出导丝。
结果
在任何情况下，Acucise器械均未出现故障。电烙术激活时间为2.2秒（范围为2 - 4秒）。56例病例中有53例（94.6%）发生造影剂外渗（透视可见）。没有任何术中出血的证据。
结论
该研究表明，以标准化方式常规进行Acucise肾盂内切开术可以在很大程度上排除术中器械故障并消除并发症，同时在UPJ中实现成功切开。根据本研究中使用的指南，我们认为Acucise肾盂内切开术可以在大多数选定的UPJ梗阻患者中成功安全地完成。
PURPOSE
The study here presented was done to test the technical reliability and immediate efficacy of the Acucise device using a standardized technique.
MATERIALS AND METHODS
56 Acucise procedures were performed in pigs by a single surgeon who used a standardized technique: insert 5F angiographic catheter bilaterally up to the midureter, perform retrograde pyelogram, Amplatz super-stiff guidewire is advanced up to the level of the renal pelvis, angiographic catheters are removed, Acucise catheter balloon is advanced to the ureteropelvic junction (UPJ) level, the super-stiff guide-wire is removed and the contrast medium in the renal pelvis is aspirated and replaced with distilled water, activate Acucise at 75 watts of pure cutting current, keep the balloon fully inflated for 10 minutes, perform retrograde ureteropyelogram to document extravasation, remove Acucise catheter and pass an ureteral stent and remove guide-wire.
RESULTS
In no case did the Acucise device present malfunction. The electrocautery activation time was 2.2 seconds (ranging from 2 to 4 seconds). The extravasation of contrast medium, visible by fluoroscopy, occurred in 53 of the 56 cases (94.6%). In no case there was any evidence of intraoperative hemorrhage.
CONCLUSIONS
This study revealed that performing Acucise endopyelotomy routinely in a standardized manner could largely preclude intraoperative device malfunction and eliminate complications while achieving a successful incision in the UPJ. With the guidelines that were used in this study, we believe that Acucise endopyelotomy can be completed successfully and safely in the majority of selected patients with UPJ obstruction.