Hem-o-lok结扎夹常规处理后腹腔镜肾切除术中肾动静脉的临床研究(附34例报告)

Clinical research of routine renal artery and vein control using the Hem-o-lok clips in retroperitoneal laparoscopic nephrectomy (report of 34 cases)

目的：探讨Hem-o-lok结扎夹在后腹腔镜肾切除术中处理肾动静脉的安全有效性。方法：2007年6月-2009年6月行后腹腔镜肾切除术34例,肾动静脉近心断端常规应用至少两个Hem-o-lok结扎夹控制。其中肾癌21例,肾盂/输尿管癌5例,无功能肾和萎缩肾3例,肾结核5例。结果：31例手术获得成功,2例因粘连重、出血改开放肾切除术,1例因术中器械故障改开放手术,肾动静脉均单独用Hem-o-lok结扎夹成功控制。手术时间45-150min,平均100min,出血量50～200ml,平均90ml,均未输血。患者随访1月-2年,肾及输尿管肿瘤无1例复发,5例结核患者经抗结核治疗后无复发。1例发生严重后腹腔感染,积极抗感染治疗后痊愈。3例有伤口痛、麻木感,半年后上述症状消失。结论：Hem-o-lok结扎夹处理肾动静脉方便快捷、安全有效、价格适中,应作为后腹腔镜肾切除术中处理肾动静脉的标准方法。后腹腔镜肾切除术创伤小,可代替开放肾切除术。

Objective：To identify the safety and efficiency of polymer clip （Hem-o-lok） for routine control of renal artery and vein during retroperitoneal laparoscopic nephrectomy （RLPN）. Methods： From June 2007 to June 2009, 34 patients underwent RLPN, Of which 21 cases of renal cell carcinoma, 5 cases of renal pelvis/ureter cancer, 3 cases of non-functioning kidney and renal atrophy, 5 cases of renal tuberculosis. Renal arterial and venous control were achieved solely by the Hem-o-lok clips where at least two clips were applied on the patient side. Results： 31 cases of RLPN were successful, because 2 cases due to severe adhesions and bleeding, 1 case due to equipment failure during laparoscopic procedure, diverted open nephrectomy. Renal arterial and venous control using the Hem-o-lok clips were successful without any slipping of clips or uncontrolled bleeding. The mean Operating time was 100 minutes （60~150 minutes）, the mean blood loss was 90 ml （50~200 ml） without blood transfusion. Follow-up was carried out for 1-24 months, no recurrence found in any patients with renal tumor or ureter tumor; 5 cases of renal tuberculosis recovered smoothly by further anti-tuberculosis treatment; one patient suffered from serious retroperitoneal inflammation, recovered smoothly after close anti-sepsis; a sense of wound pain, numbness in 3 patients, disappeared after 6 months. Conclusion： The Hem-o-lok clip is a safe, convenient and economical device for vascular control in RLPN. RLPN with minimal invasion is expected to become the first choice for nephrectomy.