【摘要】 目的探讨基底单层缝合技术应用于腹腔镜下肾部分切除术(LPN)的适应证及在患肾功能保护上的意义。方法前瞻性纳入71例接受LPN的肾脏肿瘤患者,根据创面缝合方式分为双层缝合(缝合基底、皮质创面)组(35例)及单层缝合(只缝合基底创面)组(36例)。收集患者的年龄、血清肌酐、R.E.N.A.L.评分、患侧肾脏肾小球滤过率(GFR)、手术时间、术中出血量(EBL)、热缺血时间(WIT)、并发症及患肾术后6个月GFR变化率(ΔGFR)等资料,并进行数据比较。结果单层缝合组的EBL[(202.78±136.08)ml]显著多于双层缝合组[(139.14±63.12)ml,P=0.014],WIT[(15.08±4.98)min]显著短于双层缝合组[(21.34±3.48)min,P=0.01],术后6个月ΔGFR[(13.36±3.37)%]略低于双层缝合组[(14.97±3.74)%,P=0.062]。R.E.N.A.L.评分≥6分时,单层缝合组的EBL显著多于双层缝合组(P=0.01);R.E.N.A.L.评分<6分时,单层缝合组的术后6个月ΔGFR显著低于双层缝合组(P=0.018)。单层缝合组中有2例患者术中出血>400ml、1例术后尿漏,双层缝合组中有1例术后假性动脉瘤形成,两组并发症发生率差异无统计学意义(P=0.248)。结论在LPN中采用单层缝合法处理R.E.N.A.L.评分较低肿瘤,可以通过缩短WIT,减少健康肾实质丢失而有利于患肾功能保护,且不会增加并发症发生风险。在复杂肿瘤中,单层缝合法可能导致出血量的显著增加,且无法在肾功能保护方面显著获益,应谨慎使用。更多还原

【Abstract】 Objective To evaluate the safety and efficacy on renal function protection of single-layer suture technique in laparoscopic partial nephrectomy(LPN). Methods Seventy-one patients receiving LPN had being recruited prospectively and divided into groups according to the suture type of double-layer(including base and cortex,35 cases)and single-layer(base only,36 cases).The data including age,serum creatinine,R.E.N.A.L.score,glomerular filtration rate(GFR)of affected kidney,operative time,estimated blood loss(EBL),warm ischemia time(WIT)and complication morbidity were collected.The change of GFR 6 months postoperatively was also recorded.Results EBL of single-layer group [(202.78±136.08)ml]was more than that of double-layer group[(139.14±63.12)ml,P=0.014],but WIT of single-layer group[(15.08±4.98)min]was shorter than that of double-layer group [(21.34±3.48)min,P=0.01].Loss of GFR 6 months postoperatively of single-layer group[(13.36±3.37)%]was slightly lower than that of double-layer group[(14.97±3.74)%,P=0.062].In the subgroup of R.E.N.A.L.score≥6,EBL of singlelayer suture was more than that of double-layer suture(P=0.01).Loss of GFR 6 months postoperatively of single-layer group was lower than that of double-layer suture(P=0.018)in the subgroup of R.E.N.A.L.score<6.Two patients in single-layer group had EBL over 400 ml.One patient in double-layer group had pseudoaneurysm,while 1 patient in single-layer group had postoperative urine leakage.No difference of complication morbidity had been found between groups(P=0.248). Conclusions For renal tumors of lower R.E.N.A.L.score,single-layer suture during LPN has advantages on the protection of renal function due to shorter WIT and more volume of healthy cortex,with no risk of higher complication morbidity,compared with double-layer suture.However,the application of single-layer suture should be used cautiously in complex tumor of higher R.E.N.A.L.score,due to the possibility of excessive EBL and inconspicuous value of renal function protection.更多还原