后腹腔镜肾部分切除术三种不同缝合方式有效性及安全性的比较研究

Comparative research on safety and efficacy among three different types of suture in retroperitoneoscopic partial nephrectomy

目的：评价后腹腔镜肾部分切除术三种不同缝合方式的安全性及有效性。方法：2009年3月-2015年2月采用后腹腔镜肾部分切除术治疗肾肿瘤患者320例,术中行单层8字形间断缝合肾脏创面者80例（A组）,行Hemolok免打结缝合法125例（B组）,行双向倒刺可吸收线（Quill线）两针双向缝合法115例（C组）。比较三组患者的肿瘤特性、手术时间、出血量及并发症。结果：320例后腹腔镜肾部分切除术全部顺利完成,无一例中转开放手术。三组患者年龄、体质指数、肿瘤直径、肿瘤位置的差异无统计学意义。在手术时间、引流管留置时间及术后住院时间方面,三组差异无统计学意义（P〉0.05）,其中热缺血时间、术中出血及术后并发症方面,C组优于B组及A组,差异有统计学意义（P〈0.05）。结论：Quill线两针双向缝合法在后腹腔镜肾部分切除术中的应用更能缩短热缺血时间,减少并发症,具有较好的安全性和可行性。

Objective：To evaluate the safety and efficacy among three different types of suture in retroperitoneoscopic partial nephrectomy.Method：From March 2009 to February 2015,320 patients with renal tumors accepted retroperitoneoscopic partial nephrectomy.All patients were divided into three groups including surgeries with figure-of-eight suture（group A,n=80）,with Hemolok knotless suture（group B,n=125）and two needle bidirectional suture with bidirectional barbed absorbable suture line（Quill suture line）（group C,n=115）.Patients＇ demographics,tumor characteristics,operation time,blood loss,warm ischemic time,complications were retrospectively analyzed and compared among three groups.Result：All 320 cases of retroperitoneoscopic partial nephrectomy were successful without conversion to open surgery.There was no significant difference among them with respect to patients＇ age,body mass index,tumor size,tumor location,operation time,indwelling time of drainage tube and postoperative hospital stay（P〉0.05）.There was statistical difference among three groups on the warm ischemic time,blood loss and postoperative complications（P〈0.05）.It showed that group C was superior to group A and B.Conclusion：The application of two needle bidirectional suture can shorten warm ischemic time and decrease the incidence of complications,so it＇s safer and more feasible.