“21”缝合技术联合早期序贯开放血流法在T_(1b)期单发肾肿瘤保留肾单位手术中的应用体会

The application effect of"2+1"suture technique combined with early sequential unclamping method in partial nephrectomy for T_(1b) single renal tumor

目的:探讨腹腔镜保留肾单位手术中应用“2+1”缝合技术联合早期序贯开放血流法治疗T_(1b)期单发肾肿瘤的安全性及疗效。方法:回顾分析2017年1月至2018年7月为22例T_(1b)期单发肾肿瘤患者采用“2+1”缝合技术联合早期序贯开放血流法行腹腔镜保留肾单位手术的临床资料,肿瘤直径平均(5.4±0.8)cm,R.E.N.A.L评分平均(7.5±0.8)分。结果:患者均顺利完成手术,无一例中转开放手术。手术时间平均(136.5±31.2)min,术中出血量平均(135.0±40.6)mL,热缺血时间平均(15.0±2.3)min,术中、术后无一例输血,切缘均为阴性,术后均无漏尿、切口感染、患侧肾脏萎缩等并发症发生。结论:腹腔镜保留肾单位手术中应用“2+1”缝合技术联合早期序贯开放血流法治疗T_(1b)期单发肾肿瘤,术中出血可控,热缺血时间可得到较好控制,手术安全、可靠。

Objective:To investigate the safety and efficacy of"2+1"suture combined with early sequential unclamping method in laparoscopic partial nephrectomy for patients with T_(1b) stage single renal tumor.Methods:The retrospective study analyzed the patients with T_(1b) stage single renal tumor who underwent laparoscopic partial nephrectomy via using"2+1"suture technique combined with early sequential unclamping method from Jan.2017 to Jul.2018.The average tumor diameter was(5.4±0.8)cm,and the average R.E.N.A.L score was(7.5±0.8).Results:All operations were successful,and no patients were transferred to open surgery.The average operative time was(136.5±31.2)min,the average intraoperative blood loss was(135.0±40.6)mL,and the average warm ischemia time was(15.0±2.3)min.There was no blood transfusion during or after the operation.Surgical margins were all negative.No complications such as leakage of urine,infection of incision or kidney atrophy occurred after the operation.Conclusions:It is safe and reliable to applicate"2+1"suture technique combined with early sequential unclamping method in laparoscopic partial nephrectomy for T_(1b) stage single renal tumor,because of its great ability in controlling bleeding and decreasing time of warm ischemia.