单向免打结倒刺缝线双层连续缝合在后腹腔镜肾部分切除术中的应用

发布时间：2018-04-20 20:16

本文选题：腹腔镜 + 部分切除　；参考：《中国内镜杂志》2016年04期

【摘要】：目的探讨双层连续免打结缝合,单层连续免打结缝合与单层间断缝合在肾部分切除术中的应用。方法 2011年1月-2015年1月93例肾肿瘤患者接受后腹腔镜下肾部分切除术治疗。所有手术均为同一术者完成。术中依据手术创面缝合方法分为3组。单层间断组22例,采用单层间断8字缝合,肿瘤床同时填塞止血纱布卷。单层连续组28例,采用单层可吸收缝线免打结连续缝合,应用Hem-o-loc替代打结。双层连续组共43例,为双层免打结可吸收单向倒刺缝线连续缝合。比较3组患者手术时间、围手术期结果和围手术期并发症等情况差异。结果 93例患者无中转开放,5例术中转为根治性手术。3组除肿瘤大小有差别外,性别、年龄和部位无差别。单层间断组,单层连续组,双层连续组手术时间分别为(94.00±19.00)min vs(85.00±14.00)min vs(75.00±10.00)min(P0.05),术中平均出血量分别为(131.00±57.00)ml vs(96.00±34.00)ml vs(76.00±22.00)ml(P0.05)。平均肾热缺血时间3组分别为(27.30±4.90)min vs(22.60±4.20)min vs(19.90±3.80)min(P0.05)。3组术后肠道恢复时间和术后出院时间差异无统计学意义。单层间断组、单层连续组和双层连续组术中转根治术分别为3、1和1例。术后尿瘘分别为3、1和0例。术后血肿形成分别为3、1和1例。均给予保守治疗后治愈出院。结论免打结可吸收倒刺缝线双层连续缝合可减少后腹腔镜肾部分切除术中热缺血时间,减少术中术后并发症发生。
[Abstract]:Objective to explore the application of double layer continuous knot free suture, single layer continuous knot free suture and single layer discontinuous suture in partial nephrectomy. Methods from January 2011 to January 2015, 93 patients with renal tumors were treated with retroperitoneal laparoscopic partial nephrectomy. All operations were performed by the same person. The patients were divided into 3 groups according to the suture method. Single-layer discontinuous group (22 cases) was sutured with single-layer discontinuous 8-word suture, and the tumor bed was filled with hemostatic gauze coil at the same time. 28 cases of monolayer continuous group were treated with single layer absorbable suture without knot continuous suture and Hem-o-loc instead of knots. 43 cases of double-layer continuous group were sutured continuously by double-layer non-knotted absorbable one-way inverted suture. The operative time, perioperative results and perioperative complications were compared among the three groups. Results there were no differences in sex, age and location in 93 patients with no conversion to open surgery (n = 5) except for the difference of tumor size in operation group (n = 5). The time of operation was 94.00 卤19.00)min vs(85.00 卤14.00)min vs(75.00 卤10.00 min P0.05, and the average blood loss during operation was 131.00 卤57.00)ml vs(96.00 卤34.00)ml vs(76.00 卤22.00 vs(76.00 卤22.00 vs(96.00 卤22.00ml / ml respectively. There was no significant difference in intestinal recovery time and postoperative discharge time between the three groups (27.30 卤4.90)min vs(22.60 卤4.20)min vs(19.90 卤3.80)min(P0.05).3). In the single layer discontinuous group, single layer continuous group and double continuous group, 3 cases and 1 case were converted to radical operation respectively. Postoperative urinary fistula was found in 3 cases and 0 cases respectively. Postoperative hematoma formation was 3 cases and 1 case respectively. All patients were cured and discharged after conservative treatment. Conclusion double layer continuous suture without knot absorption and inverted suture can reduce the time of hot ischemia and decrease the complications during laparoscopic partial nephrectomy.
【作者单位】：厦门大学附属第一医院泌尿外科(厦门市泌尿中心);
【分类号】：R737.11

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