猪免缝合肾部分切除术中不同功率单极电凝对术肾病理损伤的影响  

Effect of different unipolar electrocoagulation power on pathological renal injury in porcine suture-free partial nephrectomy

作　　者：徐元高[1] 宋赏 裴军 李凯[1] 徐述雄[1] 罗光恒 王元林[1] 孙发 石华[1] Xu Yuangao;Song Shang;Pei Jun;Li Kai;Xu Shuxiong;Luo Guangheng;Wang Yuanlin;Sun Fa;Shi Hua(Department of Urology,Guizhou Provincial People’s Hospital,Guiyang 550002,China;Graduate School of Zunyi Medical University,Zunyi 563003,China)

机构地区：[1]贵州省人民医院泌尿外科,贵阳550002 [2]遵义医科大学研究生院,遵义563003

出　　处：《中华泌尿外科杂志》2020年第8期619-623,共5页Chinese Journal of Urology

基　　金：贵州省科技计划项目(黔科合基础(2016)1090);贵阳市科技计划项目(筑科合同(20161001)30);贵州省高层次创新型人才培养(GZSYQCC(2014)005)。

摘　　要：目的探讨免缝合肾部分切除术(SFPN)中不同功率单极电凝对猪肾的病理损伤程度。方法2018年4—7月,选取贵州小型猪9头,平均年龄3岁,平均体重48 kg。9头猪均行开放式SFPN,根据术中单极电凝止血功率不同分为60W、80W、100W 3组,每组各3头。手术取左侧与腰骶肌平行切口,动脉夹夹闭左肾动脉,于左肾中极切除约2 cm×2 cm×2 cm肾组织,分别采用60W、80W、100W单极电凝止血,然后松开动脉夹观察创面出血情况,如有出血继续夹闭动脉夹后电凝止血,直至松开动脉夹后肾脏创面无出血,肾动脉夹闭总体阻断时间均控制在20 min。术中应用多路测温仪探针于距离单极电凝钩2 mm、5 mm、10 mm处和远离操作区域的肾上极垂直肾脏切面插入正常肾组织,测量温度。记录手术时间、肾脏出血量、术中止血时间和上述测温部位的温度。术后第7天取术肾行病理检查,观察肾脏病理变化。结果9头猪手术均顺利完成,60W、80W、100W组手术时间分别为(41.2±5.5)min、(35.1±3.7)min、(31.3±2.2)min,组间比较差异无统计学意义(P>0.05);肾出血量分别为(35.3±4.1)ml、(21.4±4.7)ml、(15.3±4.1)ml,100W组和80W组出血量少于60W组(P<0.05),100W组出血量少于80W组(P<0.05);止血时间分别为(15.2±1.9)min、(10.1±1.4)min、(6.4±0.8)min,100W组和80W组止血时间少于60W组(P<0.05),100W组止血时间少于80W组(P<0.05)。3组距离电凝钩2 mm、5 mm、10 mm处的温度均依次降低,且差异有统计学意义(P<0.05)。距离电凝钩10 mm处60W、80W、100W组的温度分别为(33.1±1.1)℃、(34.0±1.0)℃、(34.3±0.6)℃,3组间比较差异无统计学意义(P>0.05),3组与各自肾上极温度比较差异无统计学意义(P>0.05)。在距离电凝钩5mm和2mm处,100W组[(41.7±1.3)℃、(61.4±6.4)℃]和80W组[(38.6±2.4)℃、(50.3±6.0)℃]的温度高于60W组[(36.9±4.1)℃、(42.0±4.7)℃],且100W组温度高于80W组(P<0.05)。病理检查60W、80W、100W组创面病理损伤Objective To explore the efficacy of different unipolar electrocoagulation power on pathological injury of porcine kidney suffering suture-free partial nephrectomy(SFPN).Methods From April 2018 to July 2018,nine Guizhou pigs were selected,with an average age of 3 years and an average weight of 48 kg.According to different hemostatic power of unipolar electrocoagulation during open partial nephrectomy,they were divided into three groups(60W group,80W group,and 100W group),with 3 in each group.The left kidney was exposed with a surgical incision,parallel to the lumbosacral muscle.The left renal artery was clamped and about 2 cm renal tissue was excised at the middle pole of the left kidney.60W,80W and 100W were used by unipolar electrocoagulation for hemostasis until no bleeding occurred after the artery clamp was released.The total ischemia time was controlled within 20 min.Temperature was measured by a multi-channel thermometer probe which was inserted into the healthy kidney tissue at a distance of 2 mm,5 mm,and 10 mm away from the unipolar electrocoagulation hook,and the upper pole of the kidney far away from the operation area.The time of operation,the volume of renal bleeding,the time of hemostasis and the temperature were recorded.On the 7th day after operation,the left kidneys were taken and the pathological changes were observed by toluidine blue staining.Results All operations were completed safely and successfully.The operation time in 60W group,80W group,and 100W group was(41.2±5.5)min,(35.1±3.7)min,(31.3±2.2)min,respectively.There was no significant difference of operation time among those group(P>0.05).The blood loss of renal was(35.3±4.1)ml,(21.4±4.7)ml,(15.3±4.1)ml,respectively.The blood loss in the 100W group and 80W group was less than that in the 60W group(P<0.05).And the blood loss in the 100W group was less than that in the 80W group(P<0.05).The hemostasis time was(15.2±1.9)min,(10.1±1.4)min,(6.4±0.8)min.The hemostasis time in the 100W and 80W groups was less than that in the 60W group

关 键 词：猪 肾部分切除术 免缝合 电凝 功率 

分 类 号：R699.2[医药卫生—泌尿科学]