机器人辅助腹腔镜肾部分切除术创面缝合技巧和效果分析(附76例报告)

doi:10.19558/j.cnki.10-1020/r.2018.03.003

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摘要 目的: 探讨机器人辅助腹腔镜肾部分切除术缝合技巧手术方法和效果。方法: 对2015年3月~2016年3月收治的76例肾肿瘤患者行机器人辅助腹腔镜肾部分切除术。根据肿瘤位置(肾脏腹侧/背侧)选择不同的入路(经腹腔/后腹腔)。肾周脂肪囊内充分游离肾脏肿瘤,于肾脂肪囊背侧与腰大肌间相对无血管间隙游离肾动脉,钝锐结合沿着假包膜切除完整肾肿瘤,对于较大的肿瘤创面,应用倒刺线双层垂直分层交叉缝合技术对合创面,观察手术时间、热缺血时间,术中出血量和术中及术后并发症及手术效果。结果: 76例手术均获得成功,无中转根治术,无中转开放,手术时间为90 min(60~140)min。热缺血时间18 min(16~24 min),术中出血50 ml(20 ~150 ml)。术中、术后均未输血。无术后血尿,无尿漏,无动静脉瘘,无假性动脉瘤等并发症。病理结果皆切缘阴性,69例肾透明细胞癌,2例嫌色细胞癌,5例肾血管平滑肌脂肪瘤。结论: 倒刺线双层垂直交叉缝合技术对合肾脏创面,是一种安全、有效的技术。对于预防术后创面出血、尿漏、动静脉瘘以及假性动脉瘤的发生有良好的效果。

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	刘启明
	高宇
	马鑫
	李宏召
	王保军
	张旭

关键词 ：机器人辅助腹腔镜技术, 肾部分切除术, 缝合技术

Abstract：Objective: To investigate the technique and results of vertical-cross suture for the renal defect in Robot-assisted laparoscopic partial nephrectomy. Methods: Robot-assisted laparoscopic partial nephrectomy was performed on 76 cases of renal tumor from Mar. 2015 to Mar. 2016. Different approaches (transperitoneal/retroperitoneal) were adopted according to different tumor sites (ventral/dorsal). The renal tumor was fully mobilized in perinephric fat. Renal artery was exposed in the vessel-free space between the perinephric fat and psoas major. The tumor was completely resected along the pseudocapsule sharply and bluntly. For the large renal defect, the novel vertical-cross suture by barbed thread was used. The operation time, warm ischemia time, estimated blood loss, complications during and after operation and the operative efficacy were observed. Results: All the operations were successfully completed. No radical nephrectomy and open surgery conversion were done. The median operative time was 90 min (60-140 min), median warm ischemia time was 18 min (16-24 min) and median estimated blood loss was 50 mL (20-150 mL). No transfusion occured during and after the operation. There were no post-operative hematuria, urine leakage, aeterial-venous fistula, pseudoaneurysm and other severe complications. All the cases achieved negative surgical margin. Pathologically, there were 69 cases of clear cell renal cell carcinoma, 2 cases of chromophobe renal carcinoma, and 5 cases of angiomyolipomas. Conclusions: Vertical-cross suture by barbed thread is safe and feasible for the renal defect. It is effective in prevention of post-operative bleeding, urine leakage and pseudoaneurysm.

Key words： robot-assisted laparoscopic partial nephrectomy suture technique

收稿日期: 2018-05-02

ZTFLH:

R737.11

通讯作者: 张旭,xzhang@foxmail.com

引用本文:

刘启明, 高宇, 马鑫, 李宏召, 王保军, 张旭. 机器人辅助腹腔镜肾部分切除术创面缝合技巧和效果分析(附76例报告)[J]. 微创泌尿外科杂志, 2018, 7(3): 154-158.
Liu Qiming, Gao Yu, Ma Xin, Li Hongzhao, Wang Baojun, Zhang Xu. Effect of vertical-cross suture technique for the renal defect in Robot-assisted laparoscopic partial nephrectomy (Report of 76 cases). JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2018, 7(3): 154-158.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1366.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2018/V7/I3/154

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