本文選題：腹腔鏡 + 部分切除　； 參考：《中國內鏡雜志》2016年04期

【摘要】：目的探討雙層連續(xù)免打結縫合,單層連續(xù)免打結縫合與單層間斷縫合在腎部分切除術中的應用。方法 2011年1月-2015年1月93例腎腫瘤患者接受后腹腔鏡下腎部分切除術治療。所有手術均為同一術者完成。術中依據(jù)手術創(chuàng)面縫合方法分為3組。單層間斷組22例,采用單層間斷8字縫合,腫瘤床同時填塞止血紗布卷。單層連續(xù)組28例,采用單層可吸收縫線免打結連續(xù)縫合,應用Hem-o-loc替代打結。雙層連續(xù)組共43例,為雙層免打結可吸收單向倒刺縫線連續(xù)縫合。比較3組患者手術時間、圍手術期結果和圍手術期并發(fā)癥等情況差異。結果 93例患者無中轉開放,5例術中轉為根治性手術。3組除腫瘤大小有差別外,性別、年齡和部位無差別。單層間斷組,單層連續(xù)組,雙層連續(xù)組手術時間分別為(94.00±19.00)min vs(85.00±14.00)min vs(75.00±10.00)min(P0.05),術中平均出血量分別為(131.00±57.00)ml vs(96.00±34.00)ml vs(76.00±22.00)ml(P0.05)。平均腎熱缺血時間3組分別為(27.30±4.90)min vs(22.60±4.20)min vs(19.90±3.80)min(P0.05)。3組術后腸道恢復時間和術后出院時間差異無統(tǒng)計學意義。單層間斷組、單層連續(xù)組和雙層連續(xù)組術中轉根治術分別為3、1和1例。術后尿瘺分別為3、1和0例。術后血腫形成分別為3、1和1例。均給予保守治療后治愈出院。結論免打結可吸收倒刺縫線雙層連續(xù)縫合可減少后腹腔鏡腎部分切除術中熱缺血時間,減少術中術后并發(fā)癥發(fā)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 鹵19.00)min vs(85.00 鹵14.00)min vs(75.00 鹵10.00 min P0.05, and the average blood loss during operation was 131.00 鹵57.00)ml vs(96.00 鹵34.00)ml vs(76.00 鹵22.00 vs(76.00 鹵22.00 vs(96.00 鹵22.00ml / ml respectively. There was no significant difference in intestinal recovery time and postoperative discharge time between the three groups (27.30 鹵4.90)min vs(22.60 鹵4.20)min vs(19.90 鹵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.
【作者單位】： 廈門大學附屬第一醫(yī)院泌尿外科(廈門市泌尿中心);
【分類號】：R737.11

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