倒刺线一针连续缝合法在保留肾单位肾肿瘤切除术中的应用  

Application of one needle continuous suture with barbed thread in nephron sparing nephrectomy

作　　者：王祖恒 刘喆 黄杰 赵晓东 陈宇豪 张可心 张廷玲 达建萍 葛京平 程文 WANG Zuheng;LIU Zhe;HUANG Jie(Clinical Medical School,Jinling Clinical Medical College of Nanjing Medical University,Nanjing 210002,China;不详)

机构地区：[1]南京医科大学金陵临床医学院,210002 [2]东部战区总医院泌尿外科

出　　处：《临床外科杂志》2023年第6期587-591,共5页Journal of Clinical Surgery

基　　金：江苏省第五期“333高层次人才培养工程”(BRA2018097)。

摘　　要：目的探讨倒刺线一针连续缝合法在腹腔镜保留肾单位肾肿瘤切除术中的临床安全性及疗效。方法东部战区总医院2017年1月~2021年1月行保留肾单位肾肿瘤切除术的病人140例。根据手术创面缝合方法分为倒刺线一针连续缝合组(A组,70例),Hem-o-lok免打结分层缝合组(B组,70例)。比较两组的手术时间、热缺血时间、术中出血量、手术前后血红蛋白及肌酐变化、引流管留置时间、住院时间以及术后并发症发生情况。结果140例病人均为腹腔镜保留肾单位肾肿瘤切除术,术中均未转行开放手术或根治性手术。两组病人性别、年龄、身高、体重及肿瘤大小、侧别、R.E.N.A.L评分和病理类型分期等比较,差异均无统计学意义(P>0.05)。两组手术时间分别为(107.4±25.2)分钟和(110.9±21.7)分钟、引流管留置时间分别为(4.1±1.2)天和(4.2±1.4)天、住院时间分别为(9.4±2.1)天和(8.5±3.4)天,两组比较差异无统计学意义(P>0.05),均未发生术后漏尿等严重并发症。A组和B组热缺血时间分别为(19.9±3.3)分钟和(23.9±4.9)分钟、术中出血量分别为(110.8±65.9)ml和(167.9±125.4)ml、手术前后血红蛋白下降值分别为(8.9±5.6)g/L和(12.7±8.3)g/L、肌酐变化分别为(9.6±8.6)μmol/L和(13.9±14.4)μmol/L,两组比较,差异有统计学意义(P<0.05)。结论对于肾肿瘤剜除创面(尤其累及肾盂者),采用倒刺线行“一针连续缝合法”,其操作简便,效果确切,可有效减少围手术期大出血与尿漏等并发症,显著缩短创口闭合时间,能做到尽快地松解阻断肾动脉的血管夹,可以确切防止肾组织因医疗性热缺血而导致的残存肾组织与功能的过度损伤。Objective To investigate the clinical safety and efficacy of one needle continuous suture with barbed thread in laparoscopic nephron sparing nephrectomy.Methods The clinical data of 140 patients who underwent nephron sparing nephrectomy from January 2017 to January 2021 were analyzed retrospectively.Those patients were divided into two groups according to the surgical wound suture method.Among them,there were 70 cases in the barbed thread one needle continuous suture group and 70 cases in the Hem-o-lok knot free layered suture group.The operation time,warm ischemia time,intraoperative bleeding,changes of hemoglobin and creatinine before and after operation,drainage tube extraction time,length of hospital stay and postoperative complications were compared between the two groups.Results All 140 patients underwent laparoscopic nephron sparing nephrectomy,and no open operation or radical operation was performed during the operation.There was no significant difference in gender,age,height,weight,tumor size,side,R.E.N.A.L score and pathological type and stage between the two groups(P>0.05).The operation time[(107.4±25.2)min vs(110.9±21.7)min],the indwelling time of drainage tube[(4.1±1.2)d vs(4.2±1.4)d]and length of hospital stay[(9.4±2.1)d vs(8.5±3.4)d]in one needle continuous suture group and Hem-o-lok knot free layered suture group had no significant difference(P>0.05).Compared with Hem-o-lok knot free layered suture group,the one needle continuous suture group had significantly shorter warm ischemia time[(19.9±3.3)min vs(23.9±4.9)min],significantly less intraoperative bleeding[(110.8±65.9)ml vs(167.9±125.4)ml],and significantly lower decrease of hemoglobin[(8.9±5.6)g/L vs(12.7±8.3)g/L]and higher increase of creatinine[(9.6±8.6)μmol/L vs(13.9±14.4)μmol/L]before and after operation(P<0.05).Conclusion For the enucleation wound of renal tumor(especially those involving the renal pelvis),the“one needle continuous suture method”with barb line is simple and effective.It can effectively reduce the compl

关 键 词：肾肿瘤 肾部分切除术 热缺血时间 缝合技术 

分 类 号：R737.11[医药卫生—肿瘤]