提前贯穿缝合的腹腔镜肾部分切除术的安全性和有效性分析(附7例报告)

目的简要介绍本科在零缺血肾部分切除术方面的改良探索,即通过提前贯穿缝合来达到切除肾肿瘤中止血目的腹腔镜肾部分切除术。方法收集并分析2013年10月到2015年1月期间7名T1a期肾肿瘤患者行提前贯穿缝合的非夹闭腹腔镜肾部分切除术的围术期资料。结果所有手术均顺利完成,没有患者中途中转开放或行根治性肾切除术,患者平均年龄是48岁,平均肿瘤大小是2.2cm。提前贯穿缝合的非夹闭腹腔镜肾部分切除术手术时间为76~152分钟,手术时间均值为89分钟,术中热缺血时间为0分钟。手术过程中出血量为160~750ml,均值约235ml。术前术后的肌酐和尿素氮差别并不明显(BUN,P=0.39;Scr,P=0.78)。结论提前贯穿缝合的腹腔镜肾部分切除术在手术临床安全性方面是可行的,应根据肿瘤的特点个体化选择合适的手术方式。

The Safety and Effectiveness Analysis of Off-clamp Laparoscopic Partial Nephrectomy under Pre-transfixing Suture

Objective To introduce our experience of off -clamp laparoscopic partial nephrectomy under pre-transfixing suture and evaluate the feasibility and safety of the surgery. Methods Analysis the perioperative outcomes of 7 patients with T1 a tumors who underwent off-clamp laparoscopic partial nephrectomy under pre-transfixing suture from November 2013 to January 2015 . Results All LPNs were completed without conversion to open surgery or radical nephrectomy. The mean age was 48 year,the mean tumor size was 2. 2 cm. The mean operation time of off-clamp laparoscopic partial nephrectomy under transfixing suture was 89 minutes (76~152 minutes). The mean estimated blood loss was 235ml (160~750ml). The blood urea nitrogen and serum creati-nine were not significantly different before and after surgery (BUN,P=0. 39;Scr,P =0. 78). Conclusions Laparoscopic partial nephrectomy with off-clamp under transfixing suture is safe and technically feasible.