摘要目的 探讨倒刺缝合在腹腔镜下肾部分切除术治疗复杂性肾肿瘤中的安全性和有效性. 方法 2009年3月至2012年3月对78例复杂性肾肿瘤(R.E.N.A.L评分≥7)患者采用腹腔镜下肾部分切除术治疗,术中均采用分层连续缝合.根据肾脏缝合方法分为倒刺组和传统组.倒刺组30例,男18例,女12例.平均年龄48岁.采用2-0倒刺线1根,自线中间剪成2根,先于线尾固定1枚Hem-o-lok夹,用于缝合肿瘤床内层,1-0倒刺线缝合外层.传统组48例,男36例,女12例.采用15 cm 2-0单乔线,内层缝合方法同倒刺组,外层采用20 cm 1-0可吸收线,连续缝合肾缺损,每针出肾包膜后均夹1枚Hem-o-lok夹.比较两组患者手术时间、围手术期结果、围手术期并发症等.结果 传统组与倒刺组手术时间分别为79、73 min,术中估计平均出血量分别为120、102 ml,两组间比较差异均无统计学意义(P＞0.05).平均肾热缺血时间传统组为25 min,倒刺组为18 min,两组比较差异有统计学意义(P＜0.05).传统组中1例术中开放血管后出血较多,遂中转开放手术;5例术后输血;1例术后出现漏尿,给予留置双J管;1例于术后16 d出现延迟出血,行选择性肾血管栓塞治疗,1例术后出现切口疝,行修补治疗.倒刺组无术中并发症,1例术后2d出血,予输血.1例出现漏尿,予留置双J管治疗,1例术后出现淋巴漏,经改变饮食保守治疗后治愈.两组术后30 d内血清肌酐比较差异无统计学意义(P＞0.05),无需二次入院治疗的患者.出血后需干预的病例传统组为7例(14.5％),倒刺组为1例(3.3％),两组比较差异无统计学意义(P＞0.05). 结论 倒刺缝合在腹腔镜下肾部分切除术治疗复杂性肾肿瘤中可以缩短平均热缺血时间,可能减少围手术期出血率.

abstractsObjective To evaluate the efficacy of self-retaining suture (QuillTM SRS) in retroperitoneal laparoscopic partial nephrectomy for complicated renal tumor by assessing perioperative parameters.Methods Between 2010 and 2012,78 cases of complicated renal tumor (R.E.N.A.L score ≥ 7) treated by retroperitoneal laparoscopic partial nephrectomy (LPN) with two layers continuous knotless barbed suture (QuillTM SRS group) (n=30) or traditional absorbable vicyl suture (non-SRS group) (n=48) were retrospectively analyzed.In QuillTM SRS group,2-0 Quill SRS was used to suture the deep wound bed,and the second outcr layer renorrhaphy was performed with a 1-0 Quill SRS by the same way.In non-SRS group,the inner layer was sutured using a 15cm in length 2-0 monicryl suture by the same method mentioned above.A second outer layer was sutured with 1-0 vicryl suture across the wound.Cases were matched for R.E.N.A.L score.Comparison was made in term of operation time,preoperative parameter and perioperative complications between SRS group and non-SRS group.Results Renorrhaphy was successfully performed in all cases except 1 case converting to open surgery in non-SRS group.Mean warm ischemia time in SRS group was shorter than non-SRS group (18 vs 25 min,P =0.021).The proportion of bleeding requiring intervention in the non-SRS group (7/48,14.5％) was 4.3-fold higher than that of the SRS group (1/30,3.3％),but the differernce is not significant (P＞0.05).There were no significant differences between two groups in postoperative creatinine changes.Limitations of this study include the absence of randomization and the relative small sample size.Conclusions SRS can be safely used for complicated renal tumor during LPN,and SRS can significantly reduce the WIT and may also reduce bleeding during the operation.