双极电凝免缝合技术在后腹腔镜肾部分切除术中的应用

Application of bipolar electrocoagulation technique in retroperitoneal laparoscopic partial nephrectomy

摘要:

目的：论证双极电凝免缝合技术的安全可行性和肿瘤学效果。方法：我院2012年12月至2016年6月，共523例行后腹腔镜肾部分切除术（retroperitoneoscopic partial nephrectomy，RPN）。排除肿瘤分期大于T1a、缝线缝合或经腹腔途径腹腔镜的病例，共有75例免缝合RPN。结果：男性48例，女性27例；平均年龄为53.4岁；左侧38例，右侧37例；体质指数平均为24.1 kg/m2；平均肿瘤最大直径为1.9 cm；平均RENAL评分为4.5；平均肾肿瘤在肾实质内深度为6.9 mm；平均手术时间为133.6 min；平均热缺血时间为6.9 min；平均失血量为88.8 mL；输血1例；无中转开放；并发症发生率为9.3%；平均术后住院时间6.4 d；术前平均肌酐为71.5 mmol/L；术后平均肌酐为76.5 mmol/L；平均随访时间为32.1个月。结论：双极电凝免缝合的RPN是安全可行且能有效控制肿瘤的一种方式。鉴于它免除腹腔镜下的打结和缝合，它可能会鼓励腹腔镜新手更有信心地学习和掌握这个较为困难的手术。

Abstract:

Objective：To demonstrate the feasibility and safety of sutureless retroperitoneoscopic partial nephrectomy with bipolar co－agulation. Methods：From December 2012 to June 2016，523 patients underwent retroperitoneoscopic partial nephrectomy（RPN） at our institution were enrolled. Excluding tumor staging greater than T1a，suture or transperitoneal laparoscopic cases，there were 75 cases of sutureless RPN. Results：The average RENAL score was 4.5；the average age of patients was 53.4 years old； the body mass index was 24.1 kg/m2；the average tumor diameter was 1.9 cm；the average warm ischemia time was 6.9min；the average blood loss was 88.8 mL；blood transfusion was needed in one case；no transit was open；the complication rate was 9.3%；the average time of ischemia was 6.9min；the average postoperative hospital stay was 6.4 days；the mean creatinine was 71.5 mmol/L before operation；the average creatinine was 76.5 mmol/L after operation and the average follow-up time was 32.1 months. Conclusion：Sutureless RPN is a safe and feasible and oncological effective method. Given that it is free from laparoscopic knotting and stitching，it may encourage laparo－scopic novice to learn confidently and master this more difficult procedure.