倒刺可吸收线在后腹腔镜肾部分切除术中的应用

Application of barbed absorbable suture line in retroperitoneoscopic partial nephrectomy

目的：探讨倒刺可吸收线在后腹腔镜肾部分切除术中应用的安全性及可行性。方法2013年2月至2014年2月山西省肿瘤医院适宜行后腹腔镜肾部分切除术的患者45例，抽签法随机分为两组：缝合肾脏选用V-Loc倒刺可吸收线23例（V-Loc组）和选用Vicryl可吸收线及Hem-o-lok夹22例（对照组）。分析比较两组患者的手术时间、失血量、热缺血时间、缝合时间、术后住院时间及肾实质缝合材料费用的差异。结果所有患者后均顺利完成腹腔镜肾部分切除术，无一例中转开放，未出现术中、术后并发症。术后病理报告肾透明细胞癌37例，乳头状肾细胞癌3例，肾嫌色细胞癌2例，切缘均为阴性；血管平滑肌脂肪瘤3例。V-Loc组和对照组平均手术时间分别为（90.8±9.6）和（96.9±9.1）min（P〉0.05），平均失血量分别为（80.4±24.2）和（99.5±24.8）ml（P〉0.05），平均热缺血时间分别为（21.5±3.4）和（25.3±1.9）min（P〈0.05），缝合时间分别为（10.8±1.7）和（16.8±3.1）min（P〈0.05），术后住院时间分别为（5.7±1.7）和（7.1±1.9）d（P〉0.05），肾实质缝合材料平均费用分别为（1215.5±101.4）和（2073.5±301.8）元（P〈0.05）。V-Loc组在热缺血时间、缝合时间和肾实质缝合材料费用方面明显低于对照组（P〈0.05）。结论倒刺可吸收线在后腹腔镜肾部分切除术中应用能够明显缩短热缺血时间和缝合时间，节约医疗费用，具有很好的安全性和可行性。

Objective To investigate the safety and feasibility of barbed absorbable suture line in retroperitoneoscopic partial nephrectomy. Methods 45 patients who were suitable for retroperitoneoscopic partial nephrectomy from February 2013 to February 2014 were collected and randomly divided into V-Loc group and the control group. 23 cases of V-Loc barbed absorbable suture line were chosen by suture kidney in V-Loc group.There were 22 cases of coated vicryl plus antibacterial suture and Hem-o-lok clip in the control group. The differences of operative time, blood loss, warm ischemia time, suture time, hospital stay and suture material costs were compared respectively between the two groups. Results All 45 cases of retroperitoneoscopic partial nephrectomy were successfully performed, without conversion to open surgery and important intraoperative complications. Postoperative pathology report showed that there were 37 cases with renal clear cell carcinoma, 3 cases with papillary renal cell carcinoma, 2 cases with chromophobe renal cell carcinoma with negative surgical margin, 3 cases with renal angiomyolipomas. In the V-Loc group and the control group, the average operative time were （90.8±9.6） and （96.9±9.1） min （P〉0.05）, the mean blood loss were （80.4±24.2） and （99.5±24.8） ml （P〉0.05）, the mean warm ischemia time were （21.5±3.4） and （25.3±1.9） min （P〈0.05）, suture time were （10.8±1.7） and （16.8±3.1） min （P〈0.05）, respectively, postoperative hospital stay were （5.7±1.7） and （7.1±1.9） d （P〉0.05）, the average cost of renal parenchymal suture material were （1 215.5±101.4） and （2 073.5±301.8） yuan （P〈0.05）. The warm ischemia time,suture time and suture material costs in the V-Loc group were significantly lower than those in the control group （all P〈0.05）. Conclusion The application of barbed absorbable suture line in retroperitoneoscopic partial nephrectomy can shorten warm ischemia time and suture time, and save hospitalization costs, with favorable safety and feasibility.