双向倒刺可吸收线在后腹腔镜肾盂输尿管成形术中的应用

Application of bidirectional barbed absorbable suture in retroperitoneoscopic pyeloureteroplasty

目的 探讨双向倒刺可吸收线在后腹腔镜肾盂输尿管成形术的安全性及可行性.方法 2011年3月至2013年6月,我院共实施35例腹腔镜肾盂输尿管成形术,其中采用普通5-0可吸收线行成形缝合术21例（A组）,采用双向倒刺可吸收线缝合14例（B组）.A组男12例,女9例,年龄6～18岁,平均年龄14.6岁；B组男8例,女7例.年龄7～ 25岁,平均年龄16.8岁.所有病例均经B超、三维CT尿路成像（CTU）或核磁共振水成像（MRU）检查确诊为肾盂输尿管交界处狭窄.结果 35例后腹腔镜肾盂输尿管成形手术全部顺利完成,无1例中转开放,未出现大血管或邻近脏器损伤等术中并发症.A组手术时间为（79.5±21.4） min.术中出血量为（18.5±21.2） ml；B组手术时间为（61.3±13.1）min.术中出血量为（20.4±21.1）ml;术中均未输血.A组缝合时间为（22.4±3.2） min；B组缝合时间为（11.6±2.7） min.术后住院天数两组均在5～7d,平均6d.随访时间年龄l ～28个月,A组有1例患者术后尿漏,引流3d后自行恢复.两组患者随访B超复查均无再发狭窄病例、无缝线结石生成病例.结论 双向倒刺可吸收线在后腹腔镜肾盂输尿管成形术中应用能够明显缩短缝合时间,具有较好的安全性和可行性.

ObJective To investigate the safety and feasibility of bidirectional barbed absorbable suture application in retroperitoneoseopie pyeloureteroplasty. Methods Between March 2011 and June 2013, 35 eases of retroperitoneoscopic pyeloureteroplasty were performed in our hospital： 5/0 adsorbable su- ture was used in 21 eases （group A）, and bidirectional barbed absorbable suture was used in 14 eases （group B）. In group A, there were 12 males and 9 females aged 6-18 years （mean 14. 6 years）. In group B, there were 8 males and 7 females aged 7-25 years （mean 16. 8 years）. All cases were diagnosed as having ureteropelvic junction stricture by B-ultrasound, three dimensional CT urography （CTU） or magnetic reso- nance urography （ MRU ）. Methods All 35 cases of retroperitoneoscopic pyeloureteroplasty were successfully performed, without conversion to open surgery and important intraoperative complications. In group A, the operative time was （79. 5 ± 21.4） min, the blood loss was （18.5 ± 21.2） ml, and suture time was （22. 4± 3.2） rain. In group B, the operative time was （61.3± 13.1 ） min, the blood loss was （ 120. 4 ±21.1 ） ml, and suture time was （ 11.6 ± 2. 7） min, without operative blood transfusion. In two groups, hospital stay was 5-7 days （ mean 6 days）. The follow-up duration was 1 to 28 months. No re-stenosis of ureter was found any more, and there was no sutures calculi also. Conclusion The application of bidirectional barbed absorbable suture in retroperitoneoscopic pyeloureteroplasty could shorten suture time and warm-ischemia time, with good safety and feasibility, and is worthy_ of being applicated generally in clinic.