Fibrin glue-oxidized cellulose sandwich for laparoscopic wedge resection of small renal lesions
Fibrin glue-oxidized cellulose sandwich for laparoscopic wedge resection of small renal lesions
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DOI：
10.1097/01.ju.0000154165.12738.7f
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发表时间：
2005-05-01
影响因子：
6.6
通讯作者：
Clayman, RV
中科院分区：
文献类型：
--
作者：
Finley, DS;Lee, DI;Clayman, RV
目的：我们介绍使用纤维蛋白胶-氧化纤维素夹心止血的标准腹腔镜楔形切除小肾肿瘤的经验。材料和方法：从2002年5月至2003年12月，15名患者接受了腹腔镜楔形切除术，总共15个非肺门肾肿块。 1 例患者行肾门夹闭术，未进行缝合。我们使用超声波剪刀和氩气束凝固器切除肿瘤床，然后凝固。将 Tisseel（Baxter Corp.，Deerfield，Illinois）应用于切除床上，然后是一层氧化再生纤维素（Surgicel，Ethicon，Somerville，New Jersey）和最后一层 Tisseel。 结果：术前肿瘤平均大小为 2.2 X 2.2 X 2.1 cm。根据计算机断层扫描超出肾实质边界的病变百分比，将病变细分为外生性（6 例）大于 60%，内生性（4 例）小于 40%，中生性（40% 至 60%）5 例。平均手术时间为 3.8 小时（范围 3 至 5）。平均失血量为 108 毫升（范围 20 至 300 毫升）。没有患者需要输血。内生组、外生组和中生组的失血量或肌酐变化没有显着差异（分别为150、121和93 ml，以及0.03、0.07和0.04 mg/dl）。所有病例的边缘状态均为阴性（平均厚度 3.2 毫米）。平均住院时间和恢复口服摄入的时间分别为 2.7 天和 1.4 天。结论：小的外生性或中生性肾脏病变可以通过腹腔镜安全切除，无需夹闭血管。使用新型止血剂在每种情况下都实现了出色的止血效果。
Purpose: We present our experience with standard laparoscopic wedge resection of small renal tumors using a fibrin glue-oxidized cellulose sandwich for hemostasis.Materials and Methods: From May 2002 to December 2003, 15 patients underwent laparoscopic wedge resection for a total of 15 nonhilar renal masses. Renal hilar clamping was performed in 1 patient and no sutures were placed. We used ultrasonic shears and an argon beam coagulator to resect and then coagulate the tumor bed. Tisseel (Baxter Corp., Deerfield, Illinois) was applied to the resection bed, followed by a layer of oxidized, regenerated cellulose (Surgicel, Ethicon, Somerville, New Jersey) and a final layer of Tisseel.Results: Mean preoperative tumor size was 2.2 X 2.2 X 2.1 cm. Lesions were subdivided based on the percent of the lesion that extended beyond the renal parenchymal border on computerized tomography as exophytic-greater than 60% in 6 cases, endophytic-less than 40% in 4 and mesophytic-40% to 60% in 5. Mean operative time was 3.8 hours (range 3 to 5). Mean blood loss was 108 ml (range 20 to 300). No patient required blood transfusion. There was no significant difference in blood loss or change in creatinine among the endophytic, exophytic and mesophytic groups (150, 121 and 93 ml, and 0.03, 0.07 and 0.04 mg/dl, respectively). Margin status was negative in all cases (mean thickness 3.2 mm). Average hospital stay and time to the resumption of oral intake were 2.7 and 1.4 days, respectively.Conclusions: Small exophytic or mesophytic renal lesions can be safely excised laparoscopically without vessel clamping. Excellent hemostasis was achieved in each case with the newer hemostatic agents.