切缘环形缝合技术在肾部分切除术中的应用效果

Ring suture technique for renorrhaphy during partial nephrectomy in the management of renal hilar cancer

目的 探讨在肾部分切除术中采用切缘环形缝合技术处理肾门部肾细胞癌的安全性及有效性.方法 选取2009年1月至2014年1月于北京大学第一医院接受肾部分切除术,且术中采用切缘环形缝合技术的31例肾细胞癌患者纳入研究,男性21例,女性10例,年龄48- 75岁,平均（58±13）岁.所有患者采用相同的技术路线：术前留置患侧肾脏的输尿管导管;阻断肾动脉,30 s后阻断肾静脉;切除肿瘤,环形连续缝合肾脏切缘;经输尿管导管逆行注射亚甲兰溶液,修补破损集合系统;解除静脉阻断,修补破损静脉;解除动脉阻断,修补破损动脉.对缺血时间、术中出血量、术后并发症发生情况进行分析.结果 经腹膜后腹腔镜手术14例,开放手术17例.肿瘤最大径1.9-4.8 cm,平均（3.3-1.2）cm;R.E.N.A.L.评分为7-11分,中位值为8分.血管阻断时间为18.4-37.5 min,平均（24±8）min.术中出血量为90- 350 ml,平均出血量（125 ±45） ml.术中未发生难以控制的大出血,1例患者因肾静脉分支瘤栓形成术中改为肾根治性切除术.术后患者均恢复良好,3个月内无出血、血尿、尿瘘及肾脏失功能等并发症发生.结论 肾部分切除术中采用切缘环形缝合技术来处理肾门部肿瘤具有良好的安全性和有效性,可应用于复杂性肾门肿瘤的处理.

Objective To evaluate the safety and efficacy of ＂ring suture technique＂ during partial nephrectomy in the management of renal cell cancer located in renal hilar.Methods The data of 31 patients with renal cell cancer located in renal hilar who underwent partial nephrectomy from January 2009 to January 2014 in Peking University First Hospital were collected.Of the 31 patients, 21 were male, 10 were female ranging from 48 to 75 years （average age of （58 ± 13） years）.＂Ring suture technique＂ was adopted in all the operation which were performed following the same steps： a ureteral catheter was placed into ipsilateral ureter pre-operatively;renal artery was clamped first and after 30 s renal vein was also clamped;tumor was resected from kidney;the edge of renal parenchyma was sutured continuously;methylthioninium Chloride solution was injected into pelvis retrograde through the ureteral catheter, and the collecting system was repaired if needed;remove renal vein clamp and then the renal artery, repair any injury of the vascular when necessary.The renal ischemic time, blood loss and postoperative complications were analyzed retrospectively.Results Retroperitoneal laparoscopic surgery and laparotomy were performed in 14 patients and 17 patients each.Average maximum diameter of tumor was （3.3 ± 1.2）cm, and median R.E.N.A.L.nephrometry score was 8 （7-11）.Average ischemic time was （24 ± 8） minutes （18.4-37.5 minutes）.Median blood loss during operation was 130 ml （90-350 ml）, average blood loss was （125 ± 45）ml, and there was no uncontrollable massive bleeding.Radical nephrectomy was adopted in 1 case due to tumor embolus in branch of renal vein.All patients had good recovery after surgery without complications such as hemorrhage, urine leakage or renal atrophy during the first 3 months after surgery.Conclusion Ring suture technique is a safe and effective method in the management of renal hilar cancer during partial nephrectomy.