环形缝合重建在肾门肿瘤保留肾单位手术的应用(附43例报告)

Application of ring suture in nephron sparing surgery (Reports of 43 cases)

目的:研究环形缝合(Ring suture)肾门重建术在肾门部肿瘤患者中应用的安全性与有效性。方法:回顾性分析2016年1月—2021年12月复旦大学附属中山医院行保留肾单位手术环形缝合重建患者的临床资料,统计患者的一般情况、手术方式、术后并发症、随访数据。结果:共收集患者43例,其中男33例,女10例。患者平均肿瘤直径(2.9±1.1) cm,平均中山评分(8.2±0.8)分,平均R.E.N.A.L.评分(8.4±0.8)分,2例患者因肾门血管损伤改为根治性肾切除。环形缝合重建方法为将切除肿瘤后的肾门创面前后缘对合缝合,根据创面大小分两层或单层缝合。患者平均手术时间(91.0±19.1) min;平均热缺血时间(24.1±4.6) min;术后平均住院时间(5.2±1.5) d。发生相关并发症15例,其中ClavienⅠ级14例,Ⅱ级1例。35例患者获得随访,平均随访时间(32.5±19.0)个月;均未发现肿瘤转移复发。讨论:肾门部肿瘤保留肾单位手术环形缝合重建是肾实质重建的一种手术改良,不会导致术后并发症的增加,并能有效地保留肾脏功能。

Objective:To study the safety and efficacy of ring suture hilar reconstruction in patients with hilar tumors.Methods:Clinical data of selected patients who underwent nephron sparing surgery(NSS) and ring suture reconstruction from January 2016 to December 2021 at Zhongshan Hospital of Fudan University were retrospectively analysed,and the general conditions,surgical procedures,postoperative complications,and follow-up data of patients were counted.Results:A total of 43 patients’ information was collected,including 33 males and 10 females.The mean tumor diameter of the patients was(2.9±1.1) cm,the mean Zhongshan score was(8.2±0.8),and the mean R.E.N.A.L.score was(8.4±0.8).Two patients were converted to radical nephrectomy due to hilar vascular injury.Ring suture reconstruction was performed by suturing the anterior and posterior edges of the hilar wound after resection of the tumor in two layers or in a single layer,depending on the size of the wound.The mean operative time of the patients was(91.0±19.1) min;the mean warm ischemia time was(24.1±4.6) min;and the mean postoperative hospital stay was(5.2±1.5) days.Fifteen cases of related complications occurred,including 14 cases of Clavien grade Ⅰ and 1 case of grade Ⅱ.Thirty-five patients were followed up with a mean follow-up time of(32.5±19.0) months on the average,and no tumor metastasis recurrence was detected in any of them.Conclusion:Ring suture reconstruction is a surgical modification of NSS that does not increase the incidence of postoperative complications and is effective in preserving renal function.