V-loc缝线在保留肾单位手术中应用安全性的实验研究  

Anchoring strength of V-LOCTM barbed suture and Hem-o-lok clips： experimental comparison of nephro sparing surgery in porcine kidney model

作　　者：杨波[1] 王辉清[1] 过菲[1] Riccardo Autorino 许传亮[1] 王林辉[1] Jihad Kaouk 孙颖浩[1] 

机构地区：[1]第二军医大学长海医院泌尿外科,上海200433 [2]美国克利夫兰临床医学中心泌尿外科

出　　处：《中华泌尿外科杂志》2013年第9期699-704,共6页Chinese Journal of Urology

基　　金：军队临床高新技术重大项目（2010gxjs057）

摘　　要：目的 研究V-loc缝线在保留肾单位手术中应用的安全性. 方法 2010年8月针对V-1oc缝线进行了系列研究：①利用测力器和离体猪肾对比研究间断缝合、水平褥式缝合下V-loc缝线和Hem-o-lok的组织抓持力；②利用球囊扩张对比研究V-loc缝线和Hem-o-lok无结法关闭离体猪肾后的抗膨胀能力；③利用活体猪肾部分切除术验证V-loc缝线能否有效完成肾脏缺损重建.结果 在离体猪肾模型中,间断缝合时4-0和2-0 V-loc缝线和单Hem-o-lok对肾脏组织的抓持力分别为1.62、2.52和3.26 N,而2个Hem-o-lok的组织抓持力可增加到4.10 N.在水平褥式缝合中,2-0V-Loc缝线和单Hem-o-lok均能有效地抓持组织,但当牵拉力量增大到一定程度,缝线和Hem-o-lok均会对肾脏组织产生切割效应.球囊扩张试验中（30个大气压）,Hem-o-lok组能有效地关闭肾脏,V-loc缝线组的肾脏创面被部分撑开,并有多处切割痕迹出现.活体动物实验中,V-loc缝线能有效关闭肾脏缺损,切割处小的出血经短时压迫后均可停止. 结论 尽管V-loc缝线对组织的抓持力不及Hem-o-lok,且有切割肾组织的风险,但在活体动物实验中能够有效关闭肾脏缺损并减少热缺血时间,值得在临床工作中验证其安全性.Objective To compare anchoring capabilities and holding strength of Hem-o-lok clips and barbed sutures on porcine renal parenchyma. Methods An ex-vivo model was used for the study by using fresh porcine kidneys with intact renal capsule. A longitudinal incision was made on the renal capsule and parenchyma to a depth of 0.5 cm. The following sutures were tested： a 2-0 Vicryl （Covidien） with one and two Hem-o-lok clips （Weck）, 2-0 V-loc （Covidien）, and 4-0 V-loc. An interrupted suture was placed through the renal capsule and parenchyma and attached to a hand-held force tester to quantify the holding strength. The tearing strength was also measured with the force tester using a horizontal mattress suture of 2- 0 V-loc and 2-0 Vicryl secured with one Hem-o-lok clip （suture passing either through the middle or the far edge of the clip）. Then, a Nephromax balloon catheter （Boston Scientific） was placed into the parenchymal incision, which was closed by a horizontal mattress suture with ＂sliding-clip technique＂ or by using a V-loc suture. The balloon was dilated and the incision of renal parenchyma was observed. Every procedure was re- peated five times. Finally, the laparoscopy partial nephrectomy was performed with 2-0 V-loc suture in the living porcine model. Results The mean forces required for suture slippage are 2.52 N （ 2-0 V-loc suture ）, 3.26 N （2-0 Vicryl suture with one Hem-o-lok clip） and 4.10 N （2-0 Vicryl suture with two Hem-o-lok clips）. And in the 2-0 V-loc suture group, the forces to violate the renal capsule was lower than in the two Hem-o-lok clips group. Unlike the renorrhaphy using the sliding clip teehnique, the horizontal mattress clo- sure with the V-loc suture had withstand balloon dilation. However, in the living animal lab, the V-loc su- ture can facilitate renorrhaphy safely during partial nephrectomy. Conclusions The V-lot barbed suture can provide a similar holding strength with the same size Vicryl suture with one Weck clip anehor. However, we need mor

关 键 词：保留肾单位手术 肾脏重建 热缺血 安全性 

分 类 号：R737.11[医药卫生—肿瘤]