Hem-o-lok结扎夹在腹腔镜肾切除肾动脉处理失败(附4例报告)

Failures of the Polymer Self-Locking(Hem-O-Lok) Clip in Laparoscopic Nephrectomy(Report of 4 Cases)

目的:报告Hem-o-lok结扎夹在腹腔镜肾切除术中肾动脉处理失败的体会。方法:报告我院4例经后腹腔途径行腹腔镜肾切除术时Hem-o-lok结扎夹结扎肾动脉时动脉断裂出血的临床资料。男3例,女1例。平均年龄76岁(58～84岁)。肾透明细胞癌2级2例,肾透明细胞癌1～2级1例,肾盂移行细胞癌1例。行腹腔镜肾癌根治术3例,腹腔镜肾输尿管全长切除术1例。4例均经后腹腔途径行腹腔镜肾切除术,采用Hem-o-lok结扎夹结扎肾动脉和肾静脉。结果:3例Hem-o-lok结扎夹结扎肾动脉后,肾动脉结扎处近心端发生部分断裂出血,1例肾动静脉结扎切断后肾脏已完全游离在取肾脏标本时肾动脉完全断裂引起大出血。4例均改行开放手术,血管阻断钳部分阻断腹主动脉,可吸收线缝合血管断端。平均手术时间80 min(65～110 min),术中平均出血量4 50 ml(200～1 000 m1),1例术中输血800 ml。结论:腹腔镜肾切除时Hem-o-lok结扎夹结扎肾动脉具有一定的潜在危险,肾动脉一旦断裂需及时改行开放手术。

Objective： To report hemostatic failures of the Hem o lok clip during laparoscopic nephrectomy. Methods：Fours cases（3 men and 1 woman） of renal tumor or renal pelvic tumor were reported. The mean patient age was 76 years（range 58-84 years）. Among the 4 cases,3 had renal clear cell carcinoma receiving laparoscopic radical nephrectomy,and 1 had renal pelvic carcinoma receiving laparoscopic nephroureterectomy. We used Hemo lok clips to control the renal artery and the renal vein. Results：Four patients needed to open conversion for injury of renal arteries by Hem-o-lok clips. The mean operation time was 80 min（65-110 min）and the mean estimated blood loss was 450 ml（range 200-1 000 ml）, one patient needed blood transfusion. Conclusions： Properly applied Hem-o-lock clips for vascular control during renal procedures usually provide a safe option. But we should realize the potential complications when using Hem-o-lock clips.when failures occur,immediate open conversions are usu ally needed.