腹腔镜下零缺血免缝合钬激光肾部分切除术的临床应用价值

Laparoscopic Partial Nephrectomy Using Ho-YAG with " Zero-ischemia" and "Sutureless" Techniques

评价腹腔镜下零缺血免缝合钬激光肾部分切除术的临床应用价值,探讨该项技术在缩短术中肾脏缺血时间、减少肾脏组织损伤范围等方面的有效性及安全性。"零缺血"技术即术中不阻断肾动脉,"免缝合"技术即不用传统的缝线方式缝合肾脏创面止血,而是通过钬激光烧灼创面达到止血目的。根据笔者所在医院初期开展的腹腔镜下零缺血免缝合钬激光肾部分切除术及参考国内外相关文献报道情况,"零缺血"技术可最大程度减少肾脏热缺血时间,避免肾功损害,"免缝合"技术可有效减少肾脏组织损伤范围,"钬激光"应用于肾部分切除术,一方面可进行术中止血,避免对肾脏创面的缝合,另一方面相比传统的缝线缝合方式,钬激光对肾脏组织的损伤范围更小。将"零缺血"、"免缝合"、"钬激光"三种技术同时用于腹腔镜肾部分切除术,可最大程度避免术中肾功损害、减少肾脏组织的损伤范围。在掌握适应证的前提下,该项技术安全可靠,可以明显减少手术时间,缩短术中肾脏热缺血时间,减少肾脏组织的损伤范围。

To evaluate application of laparoscopic partial nephrectomy（LPN）using Ho-YAG with ＂ Zero-ischemia＂ and ＂ Sutureless＂ techniques and to explore this technique according to reduction of warm ischemia time（WIT）and reduced renal tissue damage.According to our experience of LPN,the authors aimed to explore a novel method that could avoid ischemia of kidney and reduced renal tissue damage. ＂ Zero-ischemia＂ means the doctors don＇t clamp the renal artery in operation, ＂ Sutureless＂ means the doctors don＇t stitch up the wound of kidney with surgical suture,but singe it using HoYAG.On the basis of our preliminary work about LPN using Ho-YAG with ＂ Zero-ischemia＂ and ＂ Sutureless＂ techniques,and combined with literature reports. ＂ Zero-ischemia＂ could reduce WIT to the greatest extent,avoid the damage of renal function, ＂Sutureless＂ would reduce renal tissue damage region,Ho-YAG can stop bleeding instead of stitching up would with surgical suture,and it can reduce renal tissue damage region compare to traditional suture method.Combined Zero-ischemia and Sutureless with Ho-YAG,this promising technique could avoid the damage of renal function as much as possible,and reduce renal tissue damage region to the greatest extent.The technique is feasible and secure under the premise of compatible indication,it can reduce renal tissue damage region and shorten operation time,WIT will be reduced or even eliminated.