摘要目的: 总结分层交叉（“γ”）预缝合镜头孔在机器人后腹腔肾部分切除术(RARPN)中的临床经验及效果。方法: 选取2017年4月–2018年10月期间实施RARPN的患者共计158例纳入研究。试验组53例,男39例,女14例,平均体质量指数（BMI）（25.7±3.58）kg/m2,应用分层交叉（“γ”）预缝合镜头孔。摘取脂肪时,解除镜头Trocar与机械臂的对接及弯钳的钳夹,拔出Trocar,直视下用卵圆钳整块取出脂肪,后重新固定Trocar,收紧并钳夹缝线,对接机械臂继续手术。缝合切口时,将预留的缝线退至肌肉筋膜表面,直接打结闭合切口肌层。对照组105例,男73例,女32例,平均BMI(23.3±4.35)kg/m2,利用抓钳自辅助孔Trocar分次取出脂肪,缝合切口时,采取间断缝合镜头孔肌层。结果: 试验组53例手术均成功应用分层交叉（“γ”）预缝合镜头孔取出脂肪,相比于对照组,取脂肪及镜头孔肌层缝合用时明显缩短（2.9±0.5）min vs. （3.9±2.1）min,（1.7±1.2）min vs. （3.1±2.0）min（P<0.001)。两组手术均顺利完成,无中转开放或改根治性肾切除术,术中及术后无严重并发症。结论: RARPN术中应用分层交叉（“γ”）预缝合镜头孔取出腹膜外或肾周脂肪操作方便,安全可行,可有效地扩大腹膜后空间,更好地维持气腹压力,缩短总体的切口缝合时间。
Abstract：Objective: To investigate the safety and feasibility of the layer-crossed (“γ”) pre-suture for the lens incision in the robot-assisted retroperitoneal laparoscopic partial nephrectomy (RARPN). Method: 158 cases of RARPN were included in the study from 2017 April to 2018 October. A total of 53 cases (39 males and 14 females) in study group underwent the layer-crossed (“γ”) pre-suture for the lens incision. The clamps were released, when the extra fat was taken out through the lens incision to expand the retroperitoneal surgery space. When suturing the muscle of lens incision, we drew the stitches back to muscle surface and knotted directly. A total of 105 cases in control group underwent interrupted suture for lens incision, and the fat was taken out through the assistant Trocar by forceps separately. Results: The layer-crossed (“γ”) pre-suture for the lens incision was performed successfully in all 53 cases of the study group. In the study group, the total time of taking out the extra fat and suturing the muscle of lens incision were significantly shorter than those in the control group [(2.9±0.5) min vs. (3.9±2.1) min; (1.7±1.2) min vs. (3.1±2.0) min, P < 0.001]. All 158 cases were conducted to RARPNs, and there were no serious intraoperative and postoperative complications. Conclusion: The layer-crossed (“γ”) pre-suture for the lens incision, through which the extra fat in RARPN is taken out, is safe and feasible, and it brings the effective expansion of retroperitoneal surgery space and shorter suturing time.
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