无需打结的后腹腔镜保留肾单位肾部分切除术——介绍一种快速简单的腹腔镜缝合术

目的：介绍近年来在后腹腔镜肾部分切除术（LPN）中应用的一种无需打结的缝合技术和经验.方法：术中应用＂哈巴狗＂动脉夹控制肾动脉后切除肿瘤,用4-0可吸收缝线＂8＂字形缝合肿瘤基底部明显的动脉出血部和集合系统,用1-0可吸收缝线连续缝合肾创面的缺损部,用Hem-o-lok夹夹持缝线以保持缝线的张力,因省去腔镜下打结操作,有效地缩短了热缺血时间.应用此项技术为30例肾肿瘤患者实施了LPN.结果：所有患者手术均获得成功,无中转开放手术者.平均肿瘤最大径（3.2±1.1）（0.8～7.5）cm,平均手术时间（134.3±26.4）（90～230）min,术中平均出血（97.3±67.4）（50～600）min,平均热缺血时间（24.8±6.2）（10～40）min.所有患者术后病理检查报告均切缘阴性.围手术期主要并发症为尿漏2例（6.67%）,术后肾周出血1例（3.33%）,经保守治疗后痊愈出院.结论：改进的无需打结的LPN缝合技术安全可靠,简便快速,能有效地减少热缺血时间,具有推广意义.

Eliminating Bolster Retroperitoneal Laparoscopic Partial Nephrectomy: A Accelerated and Simplified Technique of the Laparoscopic Suture

Objective.-Laparoscopic partial nephrectomy（LPN） is a demanding procedure. To Introduce a simplifying technique eliminating bolster in repair of the tumor bed for most laparoscopic urologists when LPN is performed. Methods.. Thirty patients who underwent LPN are included in this study. After tumor excision, both artery and collecting system on tumor bed were closed using ＂8＂ shaped suture with 4-0 absorbable thead. Renal parenchymal repair using a running suture with 1-0 absorbable suture. No bolster was applied in the renal defect, even in broad tumor beds. To avoid time-consuming knot tying, the sutures were buttressed by the use of Hem o-Lok clips. Warm ischemia time is reduced effectly. Data on perioperative and early postoperative outcomes were col lected prospectively. Results.-All patients were operated successfully, without conversion to open surgery. Mean tumor size was（3.2±1.1） （range 0.8-7.5） cm. Mean operation time is（134.3±26.4）minutes（range 90-230）min. Mean blood loss was（97.3±67.4）（range 50-600）ml. Mean ischemia time was（24.8±6.2）minutes （range 10-40） min. Urine leakage occurred in 2 （6.67%） patients and perirenal hematoma occurred in 1 （3.33% ） patient. All patients＇ surgical margin was negative. All of the procedures were completed laparoscopically without the need for open conversion or postoperative surgical intervention. Conclusions：LPN could be accomplished safely and simply without the use of bolster. Such an approach could reduce Warm ischemia time effectly and consequently popular ize it among urologists.