倒刺缝合线联合“2+1”缝合技术在腹腔镜肾部分切除术中的应用体会  

The application experience of barbed suture combined with “2 + 1” technology in laparoscopic partial nephrectomy

作　　者：曲发军[1] 张向民 叶剑青[1] 干思舜[1] 储传敏[1] 王磊[1] 田毅君 杨炜[1] 黄海[1] 崔心刚[1] QU Fa- jun;ZHANG Xiang-min;YE Jian-qing;et al(Department of Urology,the Third Affiliated Hospital of Second Military Medical University, Shanghai 200438, Chin)

机构地区：[1]第二军医大学第三附属医院,上海200438

出　　处：《腹腔镜外科杂志》2018年第2期123-126,共4页Journal of Laparoscopic Surgery

基　　金：上海市科研计划项目(编号:17411960200)

摘　　要：目的:总结倒刺缝线联合"2+1"缝合技术在腹腔镜肾部分切除术中的应用经验。方法:于86例腹腔镜肾部分切除术中应用倒刺缝线联合"2+1"缝合技术。肿瘤最大径平均(3.8±1.2)cm,R.E.N.A.L评分平均(7.5±1.1)分。其中20例经腹腔入路,66例经腹膜后入路。术中常规分离出肾动脉备用,切除肿瘤前阻断肾动脉,切除肿瘤后电凝创面初步止血,用V-Loc倒刺线缝合内层髓质创面,再用Quill倒刺线自上而下缝合肾脏皮质创面,开放肾血流,最后用Quill倒刺线自下而上加固缝合皮质创面。结果:手术均顺利完成,无一例中转开放。热缺血时间平均(18.1±4.2)min,术中出血量平均(38.5±6.8)ml。术后未出现严重出血等并发症。患肾功能恢复良好。结论:应用倒刺缝线联合"2+1"缝合技术可较好地完成腹腔镜肾部分切除术中的缝合操作,既能保证缝合效果的确切性,减少术中、术后发生创面出血的可能性,又能缩短肾脏热缺血时间,利于术后患肾功能的恢复。Objective： To summarize the experience of barbed suture combined with＂2 ＋ 1＂technology in laparoscopic partial nephrectomy（ LPN）. Methods： A total of 86 patients underwent LPN by barbed suture combined with ＂2 ＋ 1＂technology. The maximum diameter of tumor was（ 3. 8 ± 1. 2） cm. The score of R. E. N. A. L were（ 7. 5 ± 1. 1） point. 20 cases were operated via trans-peritoneal approach and 66 cases were treated via retroperitoneal approach. Firstly,the renal artery was separated and blocked before removing the tumors. The wound was treated by electrocautery preliminarily. Secondly,the inner wound of renal medulla was sutured with VLoc barbed suture and outer wound of renal cortex was sutured with Quill barbed suture. Thirdly,the renal artery was opened and outer wound were sutured again by Quill barbed suture. Results： All laparoscopic operations were successful without conversion to laparotomy. The mean renal warm ischemia time was（ 18. 1 ± 4. 2） min,the mean bleeding volume during operation was（ 38. 5 ± 6. 8） ml.There were no complications such as serious bleeding. The renal function recovered successfully. Conclusions： Barbed suture combined with ＂2 ＋ 1＂technology can complete suture procedure of LPN effectively. The method can ensure the accuracy of suture,decrease the perioperative wound bleeding,shorten the time of renal warm ischemia and benefit the recovery of renal function.

关 键 词：肾肿瘤 肾部分切除术 腹腔镜检查 倒刺缝合线 2+1缝合技术 

分 类 号：R737.11[医药卫生—肿瘤]