单向免打结倒刺缝线双层连续缝合在后腹腔镜肾部分切除术中的应用

Application of one-way two-layer barbed running suture in retroperitoneal laparoscopic partial nephrectomy

目的探讨双层连续免打结缝合,单层连续免打结缝合与单层间断缝合在肾部分切除术中的应用。方法 2011年1月-2015年1月93例肾肿瘤患者接受后腹腔镜下肾部分切除术治疗。所有手术均为同一术者完成。术中依据手术创面缝合方法分为3组。单层间断组22例,采用单层间断8字缝合,肿瘤床同时填塞止血纱布卷。单层连续组28例,采用单层可吸收缝线免打结连续缝合,应用Hem-o-loc替代打结。双层连续组共43例,为双层免打结可吸收单向倒刺缝线连续缝合。比较3组患者手术时间、围手术期结果和围手术期并发症等情况差异。结果 93例患者无中转开放,5例术中转为根治性手术。3组除肿瘤大小有差别外,性别、年龄和部位无差别。单层间断组,单层连续组,双层连续组手术时间分别为(94.00±19.00)min vs(85.00±14.00)min vs(75.00±10.00)min(P<0.05),术中平均出血量分别为(131.00±57.00)ml vs(96.00±34.00)ml vs(76.00±22.00)ml(P<0.05)。平均肾热缺血时间3组分别为(27.30±4.90)min vs(22.60±4.20)min vs(19.90±3.80)min(P<0.05)。3组术后肠道恢复时间和术后出院时间差异无统计学意义。单层间断组、单层连续组和双层连续组术中转根治术分别为3、1和1例。术后尿瘘分别为3、1和0例。术后血肿形成分别为3、1和1例。均给予保守治疗后治愈出院。结论免打结可吸收倒刺缝线双层连续缝合可减少后腹腔镜肾部分切除术中热缺血时间,减少术中术后并发症发生。

Objective To compare the effects among three different suture methods in retroperitoneal laparoscopic partial nephrectomy（LPN）. Methods 93 patients with renal cell carcinoma（RCC） treated by LPN were divided into three groups, as V-loc two-layer barbed absorbable running suture group with 43 cases, one-layer running suture group with 28 cases（2-0 Vicryl absorbable suture combined with Hem-o-loc in knotless continuous suture technique）. 22 cases were enrolled in one-layer interrupted suture（2-0 Vicryl absorbable suture combined with hemostatic gauze in interrupted suture technique）. Operation time, warm ischemia time, average intraoperative bleeding volume, postoperative hospital stay, and incidence of postoperative complications of the three groups were compared.Results All the 93 cases underwent successful operation, and none of them received alternative open operation. 5cases received alternative laparoscopic radical nephrectomy. All patients had negative surgical margin. The sex, age,tumor site were comparable among three groups. But the tumor diameter were different among three groups. The op-eration time among three groups（one-layer interrupted suture group, one-layer running suture group, two-layer barbed absorbable running suture group） were（94.00 ± 19.00） min vs（85.0 0± 14.00） min vs（75.00 ± 10.00） min,respectively（P〈0.05）. The warm ischemia time were（27.30 ± 4.90） min vs（22.60 ± 4.20） min vs（19.90 ± 3.80）min, respectively（P〈0.05）. The intraoperative blood loss were（131.00 ± 57.00） ml vs（96.00 ± 34.00） ml vs（76.00 ±22.00） ml, respectively（P〈0.05）. The incidence of alternative laparoscopic radical nephrectomy were 3 cases, 1case, 1 case, respectively（P〈0.05）. The incidence of urinary fistula after surgery were 3 cases, 1 case and none among three groups（P〉0.05）. The incidence of hematoma after surgery were 3 cases, 1 case and 1 case, respectively（P〉0.05）. Conclusion The applying V-loc two-layer barbed absorbable running suture in retroperitoneal laparoscopic partial nephrectomy can not only remarkably shorten warm ischemia time and operation time, but also decrease the incidence of complications such as urinary fistula and bleeding.