两种缝合方法在后腹腔镜肾部分切除术中安全性与适用性比较

Comparison on the safety and feasibility of two suture method in heminephrectomy that assisted by retroperitoneoscopy

目的评价单向倒刺可吸收缝线行单层缝合法或双层缝合法在后腹腔镜肾部分切除术中安全性与适用性。方法选择2016年5月-2019年10月本院收治的85例肾肿瘤行后腹腔镜下肾部分切除术(RLPN)患者作为研究对象,按照缝合方法分为A组(单层缝合法,40例)和B组(双层缝合法,45例)两组。根据肿瘤分期同时又分为A1[T1a期(肿瘤最大径≤4 cm),30例]组和B1(T1a期,26例)组两组。A2[T1b期(肿瘤最大径4-7 cm),10例]组和B2(T1b期,19例)组两组。A组采用单层缝合法,B组采用双层缝合法。记录手术时间、术中肾脏热缺血时间(WIT)、术中出血量、术后引流量、术后引流管拔除时间、术后住院时间、术前与术后血肌酐水平变化及术后并发症情况等指标进行统计学分析。结果A组与B组比较:两组患者术中WIT、术后引流管拔除时间、术后住院时间及术前与术后血肌酐水平变化比较,差异无统计学意义(P>0.05);而两组患者手术时间、术中出血量、术后引流量比较,差异具有统计学意义(P<0.05)。A1组与B1组比较:两组患者术中WIT、术后引流量、术后引流管拔除时间、术后住院时间及术前与术后血肌酐水平变化比较,差异无统计学意义(P>0.05);而两组患者手术时间、术中出血量比较,差异具有统计学意义(P<0.05)。A2组与B2组比较:两组患者术中WIT、术后住院时间及术前与术后血肌酐水平变化比较,差异无统计学意义(P>0.05);而两组患者手术时间、术中出血量、术后引流量、术后引流管拔除时间比较,差异具有统计学意义(P<0.05)。两组患者术后并发症发生率比较,差异无统计学意义(P>0.05)。结论单向倒刺可吸收缝线单层缝合法或双层缝合法在后腹腔镜肾部分切除术治疗T1期肾癌具有良好的安全性及适用性。T1a期肿瘤可行单层缝合,能够缩短手术时间和减少术中出血量;T1b期肿瘤可行双层缝合,可减少术后引流量,缩短引流管拔出时间。临床中根据肿瘤情况选择合适的缝合方法有助于患者手术安全和术后恢复。

Objective To evaluate the safety and applicability of single-layer suture and double-layer suture by using the absorbable barbed sutures in retroperitoneal laparoscopic partial nephrectomy.Methods A total of 85 cases of patients suffered with localized renal cancer(T1N0M0)who underwent retroperitoneal laparoscopic partial nephrectomy in our department from May 2016 to October 2019 were collected as study objects.According to suture methods,the patients were divided into two groups:Group A(single-1ayer suture,n=40)and Group B(double-layer suture,n=45).According to the different tumor stage,group A was divided into A1(T1a,maximum diameter of the tumor equal to or less than 4 cm,n=30)and A2(T1b,maximum diameter of tumor between 4cm and 7cm,n=10),group B was divided into B1(T1a,n=26)and B2(T1b,n=19).Group A adopted single seam method,group B adopted double seam method.The operative time,warm ischemia time(WIT),intraoperative hemorrhage,postoperative drainage,drainage time,hospital stay after operation,preoperative and postoperative serum creatinine(Cr)level and postoperative complications were recorded for statistical analysis.Results Comparison between group A and group B:there were no significant differences in intraoperative WIT,the time need until the drainage tube drawing,postoperative hospital stay,and the variation of serum creatinine level between the two groups(P>0.05).There were statistically significant differences in operative time,intraoperative blood loss and postoperative drainage between the two groups(P<0.05).Comparison between group A1 and group B1:there were no significant differences in intraoperative WIT,the time need until the drainage tube drawing,postoperative hospital stay,and the variation of serum creatinine level between the two groups(P>0.05).There were statistically significant differences in operative time,and intraoperative blood loss between the two groups(P<0.05).Comparison between group A2 and group B2:there were no significant differences in intraoperative WIT,postoperative hospital stay,and the variation of serum creatinine level between the two groups(P>0.05).There were statistically significant differences in operative time,intraoperative blood loss,postoperative drainage volume and postoperative drainage tube removal time between the two groups(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusions As a treatment of renal cancer for phase T1,it was safe and applicable to use single-1ayer suture or double-layer suture to suture kidney with absorbable Barbed sutures in retroperitoneal laparoscopic partial nephrectomy.When it comes to phase T1a,single-layer suture could be used for suturing kidney.The single-layer suture was helpful to reduce the operative duration and intraoperative hemorrhage.But for phase T1b,double-layer suture could help reducing the postoperative drainage and shortening the length of drainage tube removal.Choosing the appropriate suture method according to the tumor condition in clinic is helpful to the operation safety and postoperative recovery.