摘要
目的:评价后腹腔镜肾部分切除术两种不同缝合方式的安全性及预后。方法:回顾性分析314例行后腹腔镜肾部分切除术的患者资料。术中行单层8字间断缝合肾脏创面者136例,分层缝合法修补肾脏组织缺损者178例。比较两组患者临床基本资料,肿瘤特性,围手术期预后以及术后肾功能差异。结果:术后8字缝合组和分层缝合组中位随访时间分别为34个月和30个月。两组在患者年龄(P=0.064),体质指数(P=0.611),手术时间(P=0.196),术中出血量(P=0.824),术中(P=0.655)和术后并发症(P=0.135)方面没有统计学差异。分层缝合组的肿瘤直径较8字缝合组大(3.4∶2.6cm,P=0.008)。两组在肿瘤位置(P=0.396)和切缘距离(P=0.070)之间没有差异。分层缝合患者在热缺血时间(18∶20 min,P=0.021),引流管留置时间(3.7∶4.3d,P=0.022)和住院时间(5.8∶6.2d,P=0.037)方面优于8字缝合患者。两组之间肌酐(sCr)的术前术后变化差异无统计学意义(P=0.797)。评估术前术后肾小球率过滤(eGFR),分层缝合组eGFR降低程度低于8字缝合组(6.7∶8.9ml·min-1·1.73m-2),差异有统计学意义(P=0.045)。结论:分层缝合法修补肾脏创面在后腹腔镜肾部分切除术中是安全有效的。改进的腔镜下缝合技术较腔内打结技术更易掌握,并且可以有效地缩短热缺血时间,从而减少手术对肾功能的影响。
Objective:To evaluate the safety and surgical outcomes of two types of renorrhaphy technique in retroperitoneal laparoscopic partial nephrectomy.Methods:A retrospective analysis of 314 patients with renal tumors in whom retroperitoneal laparoscopic partial nephrectomy(LPN)was performed with interrupted,figure-of-eight suture(n=136)and layered parenchymal suture(n=178)between March 2008 and January 2012.All procedures were performed by the same laparoscopic surgeon(X.Z.).Patient demographics,tumor characteristics,operative outcomes,and perioperative renal functions were compared.Results:The patients were followed up for a median period of 34 months in the interrupted,figure-of-eight suture group and 30 months in the layered parenchymal suture group.There was no significant differences between them with respect to patient age(P=0.064),body mass index(P= 0.611),operative time(P=0.196),estimated blood loss(P=0.824),complications intro(P=0.655)and post operation(P=0.135).Tumor size for layered parenchymal suture group was significantly larger than interrupted,figure-of-eight suture group(3.4∶2.6,P=0.008).Tumor location(P=0.396)and margin status(P=0.070)were comparable.The layered parenchymal suture group had less warm ischemia time(WIT)(18∶20 mins,P=0.021),faster removed Jackson-Pratt drain(3.7∶4.3days,P=0.022)and shorter hospital stay(5.8∶6.2days,P=0.037)the interrupted,figure-of-eight suture group.There was a trend toward a better preserved GFR in the layered parenchymal suture group(eGFR decrease:6.7∶8.9,P=0.045).But this effect did not reach statistical significance between the two groups for objective changes in the values on serum creatinine(P=0.797).Conclusions:The renorrhaphy technique of layered parenchymal suture is safe and feasible in retroperitoneal LPN.The evolving renorrhaphy technique will make the procedure faster and more readily that may decrease WIT and improve postoperative renal function.
出处
《微创泌尿外科杂志》
2012年第1期59-63,共5页
Journal of Minimally Invasive Urology
基金
国家高技术研究发展计划(863计划)(2012AA021100)
关键词
肾肿瘤
后腹腔镜
肾部分切除术
缝合技术
kidney neoplasms
retroperitoneal laparoscopy
partial nephrectomy
renorrhaphy techniques
