腹腔镜下零缺血免缝合light-touch技术肾部分切除术的临床应用及体会  

Clinical application of laparoscopic partial nephrectomy with zero-ischemia and sutureless using light-touch technique

作　　者：王启飞[1] 李泉林[1] 车翔宇[1] 张志伟[1] 刘卫[2] 仲林[3] 吴广圳 汤奇祯[1] WANG Qi- fei;LI Quan- lin;CHE Xiang- yu;ZHANG Zhi- wei;LIU Wei;ZHONG Lin;WU Guang- zhen;TANG Qi -zhen(Department of Urology;Department of Nursing;Department of Pathology,the First Affiliated Hospital of Dalian Medical University,Dalian ll6000,China)

机构地区：[1]大连医科大学附属第一医院泌尿外科,辽宁大连116000 [2]大连医科大学附属第一医院护理部,辽宁大连116000 [3]大连医科大学附属第一医院病理科,辽宁大连116000

出　　处：《现代泌尿外科杂志》2018年第7期495-498,共4页Journal of Modern Urology

摘　　要：目的回顾总结应用light-touch技术的零缺血免缝合腹腔镜肾部分切除术(ZS-LPN)的临床效果及经验体会,探讨该技术的有效性及安全性。方法从2016年10月至2017年12月,应用笔者总结的light-touch评分方法选择大连医科大学附属第一医院18例局限性肾肿瘤患者,应用light-touch技术完成ZS-LPN,左肾肿瘤11例,右肾肿瘤7例。男13例,女5例;经腹腔途径3例,后腹腔途径15例;患者年龄34~72岁,平均55岁;肿瘤大小1.5~4.0cm,平均2.5cm。结果 15例手术为完全零缺血免缝合完成,2例因出血术野不清采用暂时阻断肾动脉后完成手术,阻断时间为11min、8min,创面均未缝合,1例零缺血下完成手术,创面常规倒刺线缝合。无中转开放手术,术中估计出血量80~300 mL,平均150 mL;手术时间81~131 min,平均98.4min;术后住院时间6~10d,平均7.4d;无术中及术后接受输血治疗病例。随访2~14个月,1例患者术后少量继发出血,保守治疗后稳定,无二次手术止血病例。1例患者术后出现尿漏,延长放置引流时间,术后7d自愈。未见肿瘤复发病例,无其他并发症。结论对于较小的局限性肾肿瘤,应用light-touch技术的ZS-LPN安全有效,可以避免术中肾脏热缺血,减少肾脏组织的损伤范围,最大程度保护肾功能,有较好的临床应用价值,值得推广。Objective To explore the clinical safety and efficacy of laparoscopic partial nephrectomy with zero-ischemia and sutureless（ZS-LPN）using light-touch technique.Methods ZS-LPN using light-touch technique was performed in 18 patients with localized renal tumor during Oct.2016 and Dec.2017,including 11 cases of left and7 cases of right renal tumor.The patients included13 males and5 females,the average age 55（34-72）years,and mean tumor size 2.5（1.5-4.0）cm.The intraperitoneal route was adopted in 3 cases,and retroperitoneal approach was adopted in 15 cases.Results The ZS-LPN using light-touch technique was successfully completed in15 cases;2 cases underwent surgery after temporary occlusion of renal artery due to hemorrhage,the blocking time being 11 min and8 min;1 case was treated with ZS-LPN,but the incision was sutured with the routine method.The average operation time was 98.4（81-131）min,estimated blood loss（EBL）was 150（80-300）mL,and postoperative hospitalization was 7.4（6-10）d.No cases needed blood transfusion during or after operation.During the followup of 2-14 months,minor secondary bleeding was observed in 1 patient,who recovered after conservative treatment;urine leakage was observed in 1 patient,who self-healed7 days after operation with prolonged drainage time.No other complications or recurrence were found.Conclusion For small localized renal tumors,ZS-LPN using light-touch technique is safe and feasible,which can avoid warm ischemia of kidney during operation,reduce renal tissue damage,and protect renal function.The technique is worthy of clinical promotion.

关 键 词：腹腔镜肾部分切除术 零缺血 免缝合 light-touch技术 

分 类 号：R616.4[医药卫生—外科学]