新型双向倒钩免打结缝合线在肾门部肿瘤腹腔镜下肾部分切除术中的应用  

Applications of new bidirectional barbed free-knot suture in laparoscopic partial nephrectomy of hilar tumors

作　　者：陈杰[1] 徐必友[1] 徐丹枫[1] 崔心刚[1] 高轶[1] 任吉忠[1] 姚亚成[1] 

机构地区：[1]第二军医大学附属长征医院泌尿外科,上海200003

出　　处：《微创泌尿外科杂志》2014年第2期84-87,共4页Journal of Minimally Invasive Urology

摘　　要：目的：评价新型双向倒钩免打结缝合线(QUI LL SRS )在腹腔镜下肾门部肾肿瘤肾部分切除术中应用的安全性及效果.方法：回顾性分析后腹腔镜肾部分切除术治疗肾门部肾肿瘤共10例,均采用 QUI LL SRS 缝线缝合肾脏.其中男6例,女4例,年龄27~69岁,平均(47.5±19.3)岁.肿瘤直径1.5~4.7 c m,平均(3.2±1.4)c m.其中腹侧7例,背侧3例,9例为单发肿瘤,1例为双侧肾肿瘤.术前按AJ CC 肾癌 TNM 肿瘤分期均为 T1 N0 M0.结果：10例均顺利完成 LPN 术.手术时间57~107 mi n ,平均(87.2±20.4)mi n .术中失血量30~180 ml ,平均(55.0±42.8)ml ,肾动脉阻断(热缺血)时间11~32 mi n ,平均(23.3±12.6)mi n .缝合时间8~21 mi n ,平均(14.3±9.7)mi n .术后住院5~8 d ,平均(6.5±1.3)d .无肾蒂血管损伤、继发性出血、尿漏等并发症,1例术后出现血尿,经保守治疗缓解.术后病理均为肾细胞癌,切缘均为阴性.随访1~6个月,无肿瘤局部复发和远处转移.缝合时间和热缺血时间明显短于普通缝线组,手术时间及继发性出血率均少于普通缝线组.结论：针对肾门部肾肿瘤,采用双向倒钩可吸收免打结线施行后腹腔镜肾部分切除术,能够明显缩短缝合时间和热缺血时间,有利于肾功能的保护,具有很好的安全性和可行性.To eval uate safety and efficacy of the new bi directional barbed free- knot absorbable suture (QUI LL SRS )in laparoscopic partial nephrecto my of hilar tu mors .Methods :The clinical data of 1 0cases of laparo-scopicpartial nephrecto my for renal hilar tu mors were retrospectivel y anal yzed .All cases were gi ven QUI LL SRS to suture the ki dney .There were 6 males and 4 fe males withage ranging from 27 to 69 years (mean [47.5 ±1 9.3 ] years ).Tu mor dia meter was 1.5-4.7 cm (average [3.2 ±1.4 ]cm).There were 7 cases of ventral tu mor and 3 cases of dorsal tu mor .Nine cases suffered from single tu mor and one from bilateral renal tu mor .All patients were fallen into T1 N0 M0 by AJ CC TNMstaging preoperativel y .Results :LPN was successfull y operated on 1 0 cases .Operation time was 57-1 07 min with an average of (87.2 ±20.4 )min .Intraoperative bl ood l oss was 30-1 80 mL with an average of (55.0 ±42.8 )mL ,renal artery occl usion (war mische mia )time was 1 1-32 min with an average of (23.3 ±1 2.6 ) min .Suture time was 8-21 min with an average of (1 4.3 ±9.7 )min .Postoperative hospital stay was 5-8 d with an average of (6.5 ±1.3 )d .No renal pedicle vascular inj ury ,secondary bleeding ,urine leakage and other co mplications occurred .Postoperative bleeding and he maturia occurred in 1 case ,and recovered after conservative treat ment .Path-ol ogical findings were all Renal cell carcino ma was pathol ogicall y confir med ,and surgical margins were negative .Af-ter foll o w- up for 1-6 months ,no l ocal recurrence and distant metastasis occurred .Suture time and war m ische mia time were significantl y shorter ,the operation time was shorter ,and secondary he morrhage rate was less in LPNthan in control group .Conclusions :Use of new bi directional barbed free- knot suture in LPN for hilar tu mors can signifi-cantl y reduce the suture time and war m ische mia time ,which is conduci ve to the protection of renal function with good safety and feasibility .

关 键 词：双向倒钩免打结线 后腹腔镜 肾部分切除术 肾肿瘤 

分 类 号：R737.11[医药卫生—肿瘤]