双向倒刺可吸收线连续缝合在腹腔镜肾部分切除术中应用临床分析

Clinical analysis of continuous kidney suture with bidirectional barbed absorbable line in retroperitoneoscopic partial nephrectomy

目的探讨双向倒刺可吸收线连续缝合肾脏在后腹腔镜肾部分切除术中应用的安全性及可行性。方法 2012年2月至2014年3月,我院共实施220例后腹腔镜肾部分切除手术,实验组（n=122）采用双向倒刺可吸收线内外连续缝合肾脏,对照组（n=98）采用普通缝线缝合肾脏,两组术前按AJCC肾癌TNM肿瘤分期均为T1N0M0。结果 220例后腹腔镜肾部分切除手术全部顺利完成,无一例中转开放,未出现严重术中并发症。实验组和对照组平均手术时间为（79.8±11.8）和（81.2±11.3）min（P=0.40）、平均缝合时间为（8.5±2.0）和（12.8±2.8）min（P〈0.01）、平均热缺血时间为（18.3±4.0）和（23.1±5.2）min（P〈0.01）。患者住院时间分别为（6.3±2.3）和（8.0±1.4）d（P〈0.01）。术后3个月实验组和对照组患肾GFR分别为（35.5±12.6）和（28.7±15.5）ml/min（P〈0.01）。实验组术后血尿4例,对照组5例（P=0.737）,实验组无尿漏发生,对照组肾缺损部位尿漏2例（P=0.071）,术后随访6-30个月,平均18.8个月,两组均无结石形成,均无肿瘤局部复发和远处转移。结论双向倒刺可吸收线连续缝合在后腹腔镜肾部分切除术中应用能够明显缩短缝合时间和热缺血时间,且不引起结石形成,具有很好的安全性和可行性,值得临床广泛推广。

Objective To investigate the safety and feasibility of continuous kidney suture with bidirectional barbed absorbable suture line in retroperitoneoscopic partial nephrectomy. MethodsBetween Feb 2012 and Mar 2014,220 cases of retroperitoneoscopic partial nephrectomy were performed in our hospital.All patients were divided into two groups：self-retaining barbed suture（SRBS）group（n=122）and non-SRBS group（n=98）.All cases were in stage T1N0M0 according to AJCC. Results All 220 cases of retroperitoneoscopic partial nephrectomy were successfully performed,without conversion to open surgery or severe intraoperative complications.The respective mean operation time were（79.8±11.8）and（81.2±11.3）min（P=0.40）in test group and control group,the mean suture time were（8.5±2.0）and（12.8±2.8）min（P〈0.01）,the mean warm ischemia time were（18.3±4.0）and（23.1±5.2）min（P〈0.01）and mean hospital duration were（6.3±2.3）and（8.0±1.4）day（P〈0.01）.The respective mean GFR were（35.5±12.6）and（28.7±15.5）ml/min（P〈0.01）after a 3-month follow-up.There were 4cases of blood urine in test group and 5cases（P=0.737）in control group.2cases of urine leakage were observed in control group and none（P=0.071）in test group.Postoperative follow-up were 6-30 month,with an average of 18.8 month.No case of stone formation was observed in both groups. Conclusions The continuous kidney suture with bidirectional barbed absorbable suture line in retroperitoneoscopic partial nephrectomy could shorten suture time,warm ischemia time,hospital stay and avoid stone formation.It is safe and feasible and worth popularizing widely.