后腹腔镜肾部分切除术中免打结分层缝合法修补肾脏组织缺损的临床应用研究

Research on the surgical application of layered parenchymal suture method in retroperitoneoscopic nephron-sparing surgery

目的:探讨后腹腔镜肾部分切除术中免打结分层缝合法修补肾脏组织缺损的临床可行性和安全性。方法:2008年12月～2010年12月,对167例肿瘤直径<4cm的肾肿瘤患者行后腹腔镜肾部分切除术。术中采用免打结技术分别缝合肾脏髓质和全层的分层缝合法修补肾脏组织缺损。观察肾脏热缺血时间、手术时间、术中出血量、术后住院天数、围手术期和近期并发症以及手术效果。结果:167例手术全部获得成功,无中转开放手术;术中平均肾脏热缺血时间(20.5±3.5)min,平均手术时间(62.1±10.6)min,术中出血量中位数30ml(10～220ml),无术中输血病例,术中肾脏组织冷冻病例检查3例,均为阴性,术后病理检查肾细胞癌肿瘤切缘均为阴性。术后住院时间中位数7d(5～13d),2例患者住院期间肾脏创面出血,予高选择性肾动脉栓塞后出血停止;术后无尿瘘病例。围手术期无死亡病例及二次手术切除肾脏病例。158例患者随访12～36个月,肾细胞癌患者均未见局部复发及远处转移,9例失访。结论:对于肿瘤直径<4cm的选择性肾肿瘤病例,后腹腔镜肾部分切除术中肾脏组织免打结缺损分层缝合法安全、有效,具有较好的临床可行性。

Objective：To evaluate the feasibility of layered parenchymal suture method in retroperitoneoscopic nephron-sparing surgery. Methods：From December 2008 to December 2010,167 patients with renal tumor underwent retroperitoneal laparoscopic nephron-sparing surgery.layered parenchymal suture method was used to repair the renal tissue defect by terms of suturing the renal cortex and the whole respectively.The operating time,warm ischemia time,estimated blood loss,hospital stay after operation,complications during and after operation and the operative efficacy were observed. Results：All procedures were technically successful.The mean warm ischemia time was（20.5±3.5） minutes,the mean operating time was（62.1±10.6） minutes,the Median of estimated blood loss was 30 mL（range from 10mL to 220 ml）,and the Median of hospital stay after surgery was 7 days（range from 5 days to 13 days）.No intraoperative complications occurred.Two cases occurred renal hemorrhage during hospitalization and were cured by subselective intrarenal embolization.No local recurrence or distant metastasis was observed during a follow-up period of 12-36 months. Conclusions：The layered parenchymal suture method in retroperitoneoscopic nephron-sparing surgery for selected renal tumor is clinical feasible.