两种缝合技术在腹腔镜肾脏部分切除术中的应用效果比较

Applications comparison of two suture techniques in laparoscopic partial nephrectomy

目的评价两种常用的缝合技术在腹腔镜肾脏部分切除术中应用的安全性及有效性。方法回顾性分析2016年5月~2018年12月在我院行后腹腔镜肾脏部分切除术的早期肾肿瘤病例54例,根据不同的缝合方法分为两组。以普通外科手术线连续缝合结合hem-lock锁扣夹逐针收紧缝合法24例(A组),行倒刺可吸收线连续缝合法30例(B组)。结合两组患者的临床资料,分析两种缝合技术对术中缝合时间、肾脏热缺血时间、术中出血量、术后持续性肉眼血尿比例、引流管拔除时间、住院时间及术后肾脏萎缩等的影响。结果53例后腹腔镜肾脏部分切除术顺利完成,1例肾门部肿瘤因缝合困难中转开放。两组患者年龄、体质指数、肿瘤直径、肿瘤位置差异无统计学意义(P>0.05)。两组术中缝合时间、术后肾萎缩比较差异无统计学意义(P>0.05);两组术中出血量、引流管拔除时间及住院时间比较差异无统计学意义(P>0.05);而A组肾脏热缺血时间、血肿形成比例、术后持续性肉眼血尿比例、漏尿优于B组,差异有统计学意义(P<0.05)。结论普通外科手术连续缝合结合hem-lock锁扣夹逐针收紧缝合法应用于后腹腔镜肾脏部分切除术,可以缩短肾脏热缺血时间,减少术后并发症的发生,减轻患者经济负担,具有临床推广价值。

Objective To evaluate the safety and efficacy of applications of two common suture techniques in laparoscopic partial nephrectomy.Methods Retrospective analysis was performed on 54 cases of early renal tumor with retroperitoneal laparoscopic partial nephrectomy in our hospital from May 2016 to Dec 2018.Patients were divided into two groups according to different suture methods.Twenty-four cases(group A)were treated with continuous suture of barb thread combined with hem-lock locking clip,and thirty cases(group B)were treated with continuous suture of absorbable barb thread.Combined with the clinical data of the two groups of patients,intraoperative suture time,renal warm ischemia time,intraoperative blood loss,postoperative persistent gross hematuria ratio,drainage tube removal time,length of stay,and postoperative renal atrophy of the two suture techniques were analyzed.Results Fifty-three cases of retroperitoneal laparoscopic partial nephrectomy were successfully completed,and one case of hilar renal tumor was opened due to suture difficulties.There were no statistical significances in age,body mass index,tumor diameter and tumor location between the two groups.In terms of intraoperative suture time and postoperative renal atrophy,there were no statistically significant differences between the two groups(P>0.05).There were no statistically significant differences between the two groups in terms of intraoperative blood loss,drainage tube removal time and length of stay(P>0.05).While in terms of renal warm ischemia time,the proportion of hematoma formation,the proportion of postoperative persistent gross hematuria and urine leakage,group A was better than group B,and there were significant differences(P<0.05).Conclusion The application of continuous suture bard thread combined with hem-lock locking clip needle-by-needle suture in retroperitoneal laparoscopic partial nephrectomy can shorten the renal warm ischemia time and reduce the occurrence of postoperative complications,which deserves clinical application.