这项研究旨在描述和评估腹腔镜技术,以促进使用同源心包植入物的马的肾脾间隙消融。保存在98%的甘油中,并使用腹腔镜聚二恶烷酮钉固定。在这项实验研究中,使用了六匹阿拉伯马,以前没有相关的腹部疾病。手术操作是在镇静下的站立姿势下使用α-2激动剂和阿片类药物进行的,与门户站点中局部麻醉剂的局部渗透有关。马匹被束缚在股票中,和左边的侧翼被剪切和无菌准备。在左翼创建了三个门户,和同源心包植入物,尺寸为10×5厘米,被引入到覆盖肾脾间隙的腹腔中,位于脾脏背侧和肾周筋膜之间,使用腹腔镜吻合器用聚二恶烷酮钉固定。在术后第0、1、3、7、14、30和60天进行体格检查以及血液和腹膜液样本收集,在第60天进行探查性腹腔镜检查,以评估该技术的有效性和最终的并发症.在手术过程中没有困难或明显的并发症,总平均执行时间为49.83分钟(±10.19)。在术后期间,与术前相比,第7天和第14天的血浆纤维蛋白原浓度显着增加(P<0.05)。在第1、3、7、14和30天,腹膜液中的总有核细胞计数增加(P<0.05)。手术60天后,体检和实验室数据均在正常范围内。第60天进行的探究性腹腔镜检查显示肾脾间隙完全闭塞,无法区分心包植入物和疤痕组织,甚至在对收集的样本进行的组织学评估中也没有。在两匹马中,在植入物固定的区域观察到网膜粘连,在另外两个人中,在植入区和结肠系膜之间观察到粘连,与临床并发症无关.在手术中对动物进行了36个月的随访,在此期间没有观察到绞痛迹象。结论肾脾间隙消融技术,使用保存在98%甘油中的同源心包,通过腹腔镜检查由聚二恶烷酮钉固定,执行起来很简单,有效,在评估期间没有临床并发症,它的使用可能被认为是在临床病例中的一种手术选择与反复肾脾截留的马。
This study aimed to describe and evaluate a laparoscopic technique to promote nephrosplenic space ablation in horses using a homologous pericardium implant, preserved in 98% glycerin and fixed using laparoscopic polydioxanone staples. In this experimental study, six Arabian horses without previous related abdominal diseases were used. The surgical procedures were performed in the standing position under sedation with alpha-2 agonists and opioids, associated with local infiltration of the local anesthetic in the portal sites. The horses were restrained in a stock, and the left flanks were clipped and aseptically prepared. Three portals were created on the left flank, and the homologous pericardium implant, measuring 10 × 5 cm, was introduced into the abdominal cavity covering the nephrosplenic space, positioned between the dorsal border of the spleen and perirenal fascia, fixed with polydioxanone staples using a laparoscopic stapler. Physical examination and blood and peritoneal fluid sample collection were performed on days 0, 1, 3, 7, 14, 30, and 60 of the postoperative period, and an exploratory laparoscopy was performed on day 60 to assess the effectiveness of the technique and eventual complications. There were no difficulties or significant complications during the surgical procedure, and the total average time to perform was 49.83 minutes (±10.19). In the postoperative period, there was a significant increase (P < .05) in the plasma fibrinogen concentration on days 7 and 14 compared with the preoperative moment. The total nucleated cell count in the peritoneal fluid increased (P < .05) on days 1, 3, 7, 14, and 30. After 60 days of the surgical procedure, the physical examination and laboratory data were within the normal range. Exploratory laparoscopy performed on day 60 revealed complete occlusion of the nephrosplenic space, and it was not possible to differentiate the pericardium implant from the scar tissue, not even in the histological evaluation performed on the collected samples. In two horses, omentum adhesion was observed in the region where the implant was fixed, and in two others, a synechia was observed between the implant area and mesocolon without association with clinical complications. The animals were followed up for 36 months at surgery, and no colic signs were observed along this period. It was concluded that the technique of ablation of the nephrosplenic space, using homologous pericardium preserved in 98% glycerin, fixed by polydioxanone staples by laparoscopy, was simple to perform, effective, and free of clinical complications during the period of evaluation, and its use may be indicated as a surgical option in clinical cases of horses with recurrent nephrosplenic entrapment.