不同缝合方法在复杂肾脏肿瘤微创手术中的效果比较

Comparison of effects of different suture methods for minimally invasive surgical operation on complex renal tumors

目的研究不同肾脏缝合方法在复杂性肾脏肿瘤微创手术中的疗效和安全。方法将我院收治的105例肾脏肿瘤患者随机分为3组,每组各35例,分别采用腹腔镜下传统"8"字间断缝合(传统组)、无打结连续缝合(连续组)或无打结分层缝合(分层组)三种术式。比较各种方法手术时间、热缺血时间、出血量、术后引流管放置时间,术后不良反应、住院时间及手术前后血肌酐变化情况。结果传统组手术时间明显长于连续组(P<0.05),分层组与传统组及连续组均无显著差异(P>0.05);热缺血时间连续组最短,分层组其次,传统组最长(P<0.05);手术出血量分层组最少,连续组其次,传统组最多(P<0.05)。分层组在引流管放置时间、住院时间明显优于传统组和连续组(P<0.05);连续组、分层组无不良反应发生率低于传统组(P<0.05);传统组手术前后血肌酐水平有差异(P<0.01),连续组、分层组无显著差异(P>0.05)。结论无打结连续缝合和无打结分层缝合比传统"8"字缝合在肾脏微创手术中效果更好且不良反应少,值得临床推广应用。

Objective To study and compare the effects of different suture methods for minimally invasive surgical operation on complex renal tumors.Methods 105 cases with complex renal tumors in our hospital were randomly divided into three groups,35 ones in each group;the patients in the traditional group received traditional laparoscopic ＂8＂ interrupted suture,ones in the continuous group did no knot continuous suture and ones in the three-layered group did no knot three-layered suture.It was compared the operation time,warm ischemia time,blood loss,postoperative drainage tube placement time,adverse reactions,length of hospital stay and postoperative serum creatinine changes before and after operation among three groups.Results The operating time of traditional group was significantly longer than that of continuous group （P ＜ 0.05） and the operating time between three-layered group and continuous group was not obviously different（P ＞ 0.05） ;warm ischemia time of continuous group was the shortest and traditional group was the longest（P ＜0.05）;Surgical blood loss of three-layered group was the least and traditional group was the most（P ＜ 0.05）;drainage tube placement time,length of hospital stay of three-layered group was superior to other two groups （P ＜ 0.05） ; incidence of adverse reactions of continuous group and three-layered group was lower than that of traditional group （P ＜ 0.05） ; there was significant differences of serum creatinine level between before and after operation in traditional group （P ＜ 0.01）,while there was no above difference in continuous group and three-layered group（P ＞ 0.05）.Condusions No knot continuous suture and no knot three-layered suture can achieve better surgical effects and have less adverse effects than traditional laparoscopic ＂8＂ interrupted suture in minimally invasive surgical operation on complex renal tumors.