后腹腔镜下双向倒刺线分层缝合肾部分切除术治疗T_(1b)期肾细胞癌的疗效(附42例报告)

Efficacy of retroperitoneal laparoscopic partial nephrectomy with layered suture using bidirectional barbed free-knot suture for T_(1b) renal carcinoma:a report of 42 cases

目的评价后腹腔镜下双向倒刺线（QUILL SRS线）分层连续缝合肾部分切除术治疗T1b期肾细胞癌的临床疗效和预后。方法回顾性分析2012年3月-2014年3月在上海长征医院行后腹腔镜下QUILL SRS线分层连续缝合肾部分切除术的42例T1b期肾细胞癌（肿瘤最大径〉4～7cm）患者的临床资料，男32例，女10例，平均年龄为（51．3±15．8）岁，平均肿瘤最大径为（5．5±1．4）cm；腹侧6例，背侧36例，均为单发肿瘤。结果42例患者均顺利完成手术。平均手术时间为（94．7±23．6）min，平均热缺血时间为（23．4±6．9）min，平均缝合时间为（17．8±8．5）min，平均术中出血量为（102．5±57．3）mL，患者均未输血，平均缝合层数为（1．8±1．0）层。术后切口感染、继发性出血、尿漏、肾蒂血管损伤等常见并发症发生率分别为7．1％、2．4％、2．4％和0。平均术后住院天数为（6．4±1．7）d。术后病理学检查切缘均为阴性，诊断为肾透明细胞癌37例，嫌色细胞癌5例。术后随访12个月，均无转移和局部复发。结论后腹腔镜下QUILL SRS线分层连续缝合肾部分切除术治疗T1b期肾细胞癌具有确切的临床疗效。

Objective To evaluate the clinical outcome and prognosis of retroperitoneal laparoscopic partial nephrectomy with layered continuous suture using bidirectional barbed free-knot suture （QUILL SRS suture） for T1b renal cell carcinoma. Methods Clinical data of 42 patients with T1b renal cell carcinoma （maximal diameter of the tumor： 〉4- 7 cm） treated with retroperitoneal laparoscopic partial nephrectomy with layered continuous suture using QUILL SRS suture between March 2012 and March 2014 in Shanghai Changzheng Hospital were retrospectively analyzed in this study. There were 32 males and 10 females, with an average age of （51.3 ± 15.8） years. The maximal diameter of tumor was （5.5±1.4） cm on average. The tumor was found in anterior in 6 cases and in posterior in 36 cases. All the tumors were single. Results The operation was successfully carried out in all cases. Average operation time was （94.7 ±23.6） min. Average warm ischemia time was （23.4 ± 6.9） rain. Average suture time was （ 17.8 ± 8.5） min. Mean intraoperative blood loss was （ 102.5 ±57.3） mL. Nobody was given a transfusion. Average suturing layers was 1.8 ±1.0. Incidence rate of incisional infection, secondary hemorrhage, urinary leakage and renal hilar injury was 7. 1%, 2.4%, 2.4% and 0, respectively Average hospital stay was （6.4±1.7） d. The results of postoperative pathological examination of surgical margin were all negative. Renal clear cell carcinoma was diagnosed in 37 patients and chromophobe renal cell carcinoma was found in 5 patients. No metastasis or recurrence was found during 12-month follow-up. Conclusion Retroperitoneal laparoscopic partial nephrectomy with layered continuous suture using QUILL SRS suture is an effective operation for T1b renal carcinoma.