关键词: 肾肿瘤, 肾部分切除术, 热缺血时间, 缝合技术

Abstract: Objective To investigate the clinical safety and efficacy of one needle continuous suture with barbed thread in laparoscopic nephron sparing nephrectomy.Methods  The clinical data of 140 patients who underwent nephron sparing nephrectomy from January 2017 to January 2021 were analyzed retrospectively.Those patients were divided into two groups according to the surgical wound suture method.Among them,there were 70 cases in the barbed thread one needle continuous suture group and 70 cases in the Hem-o-lok knot free layered suture group.The operation time,warm ischemia time,intraoperative bleeding,changes of hemoglobin and creatinine before and after operation,drainage tube extraction time,length of hospital stay and postoperative complications were compared between the two groups.Results All 140 patients underwent laparoscopic nephron sparing nephrectomy,and no open operation or radical operation was performed during the operation.There was no significant difference in gender,age,height,weight,tumor size,side,R.E.N.A.L score and pathological type and stage between the two groups(P>0.05).The operation time[(107.4±25.2) min vs (110.9±21.7)min],the indwelling time of drainage tube[(4.1±1.2)d vs (4.2±1.4)d] and length of hospital stay[(9.4±2.1) d vs (8.5±3.4)d] in one needle continuous suture group and Hem-o-lok knot free layered suture group had no significant difference(P>0.05).Compared with Hem-o-lok knot free layered suture group,the one needle continuous suture group had significantly shorter warm ischemia time[(19.9±3.3) min vs (23.9±4.9)min],significantly less intraoperative bleeding[(110.8±65.9)ml vs (167.9±125.4)ml],and significantly lower decrease of hemoglobin[(8.9±5.6)g/L vs (12.7±8.3)g/L] and higher increase of creatinine[(9.6±8.6)μmol/L vs (13.9±14.4)μmol/L] before and after operation(P<0.05).Conclusion For the enucleation wound of renal tumor(especially those involving the renal pelvis),the “one needle continuous suture method” with barb line is simple and effective.It can effectively reduce the complications such as perioperative bleeding and urinary leakage,significantly shorten the wound closure time,and release the vascular clamp blocking the renal artery as soon as possible,It can definitely prevent the excessive injury of residual renal tissue and function caused by medical thermal ischemia.

Key words: renal tumor, partial nephrectomy, warm ischemia time, suture technique