柔和电凝在肾部分切除术中安全性的实验研究

The safety of soft coagulation for partial nephrectomy in a rabbit model

目的:构造大耳白兔肾部分切除实验模型,对比使用柔和电凝止血和传统缝合止血2种手术方式,探索柔和电凝在肾部分切除术中的止血效果及安全性。方法:将12只大耳白兔分为2组,8只为实验组,4只为对照组。实验组(柔和电凝组)不阻断肾蒂,切除右肾下极3mm厚度肾脏,使用柔和电凝彻底止血后,随后切除左侧肾脏;对照组(传统缝合组):阻断肾蒂,切除右肾下极3mm厚度肾脏,缝合创面进行止血,随后切除左侧肾脏。比较2组术后第1d、1周和2周的血尿素、肌酐水平以及术后2周肾组织的病理恢复情况。结果:2组手术均顺利完成,术后2周探查手术部位未见肾周血肿和漏尿。2组血尿素和肌酐水平均在术后第1d显著升高,术后1周时下降,2组间各观察时点比较差异均无统计学意义(P>0.05)。肾脏病理改变:实验组炎症带,肾小管、肾小球结构尚可见,细胞水肿,细胞核固缩或消失。对照组炎症反应带较宽,正常肾小球肾小管结构缺失,组织结构紊乱变性坏死。结论:柔和电凝用于肾部分切除术止血效果安全可靠,尽管对肾脏组织结构影响各异,但对肾功能的影响与缝合手术无明显差异。

Objective:To investigate and compare the safety and effectiveness of soft coagulation and traditional suture hemostasis for partial nephrectomy in a rabbit model.Methods:Twelve rabbits were divided into two groups;8 were operated with soft coagulation and 4 with traditional suture hemostasis.In soft coagulation group,3-cm parenchyma of the right kidney was resected at the lower pole without clamping the renal pedicle.After thorough hemostasis by soft coagulation,the left kidney was subsequently removed.In suture group,the same resection was performed and the renal parenchyma wound was sutured for reconstruction and hemostasis with the renal pedicle clamped,then the left kidney was removed,too.Blood urea and creatinine were measured on day 1,7 and 14 postoperatively.The gross and pathological specimen on day 14 postoperatively were compared between two groups.Results:The operation of the two groups were performed safely and successfully.The surgical field was explored on day 14 postoperatively,no hematoma or urine leakage was found.The serum urea and creatinine in both groups were significantly elevated on day 1 postoperatively,then declined on day 7.Pathologically,an apparent inflammatory zone presented and the structure of renal tubule and glomerulus could be recognized with edematous cells and pyknotic nuclei in coagulation group.A wider inflammatory response and absence of normal glomerular and tubular structure were found in the control group.Conclusion:We demonstrated that the soft coagulation was safet and effective in partial nephrectomy.Although the pathological changes were different,the effects on renal function was comparable between the two groups.