Comparison of two different renorrhaphy techniques in retroperitoneal laparoscopic partial nephrectomy for complex tumor
Comparison of two different renorrhaphy techniques in retroperitoneal laparoscopic partial nephrectomy for complex tumor
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DOI：
10.3760/cma.j.issn.0366-6999.20131761
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发表时间：
2013-12
影响因子：
6.1
通讯作者：
Jiwen Shang;Xin Ma;Xu Zhang;Hong-zhao Li;T. Shi
中科院分区：
文献类型：
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作者：
Jiwen Shang;Xin Ma;Xu Zhang;Hong-zhao Li;T. Shi
背景部分肾切除术是目前临床T1肾肿瘤的标准治疗方法，因为它可以提供等同于根治性肾切除术的肿瘤预后。目的是通过评估围手术期结果，评估自保留缝线（SRS）在腹膜后腹腔镜部分肾切除术（LPN）中用于中度或高度复杂的单个肾块的再缝合技术的有效性。方法回顾性分析2010 - 2012年64例复杂肾包块（肾评分≥7）患者，其中64例分别采用连续无结刺缝线（Quill PDO SRS组，n=34）和可吸收维氏针（非SRS组，n=30）进行两层腹膜后LPN。病例进行肾评分匹配。所有手术均由同一位有500多例LPN经验的外科医生进行。比较SRS组与非SRS组患者术前预后及围手术期并发症。结果SRS组平均热缺血时间（WIT）小于非SRS组（18.0 vs. 24.8 min， P=0.021）。SRS组的再缝合成本低于非SRS组（269.6美元对335.8美元，P=0.001）。两组术后肌酐变化、肾小球滤过率及围手术期并发症发生率无显著差异。结论SRS对于复杂的肾肿瘤是安全的，在LPN中采用两层连续和不打结缝合，可显著降低WIT和再缝合成本。
Background Partial nephrectomy is currently the standard treatment for clinical T1 renal neoplasms, as it can provide oncologic outcomes equivalent to radical nephrectomy. The aim was to evaluate the efficacy of self‐retaining suture (SRS) in renorrhaphy technique in retroperitoneal laparoscopic partial nephrectomy (LPN) for a single renal mass of moderate or high complexity by assessing peri‐operative outcomes. Methods A retrospective analysis was done of 64 patients between 2010 and 2012 for complex renal mass (RENAL score ≥7) in whom retroperitoneal LPN was performed with two layers using continuous knotless barbed suture (Quill PDO SRS group; n=34) and absorbable vicryl (non‐SRS group; n=30), respectively. Cases were matched for RENAL score. All the surgical procedures were performed by the same surgeon with experience of more than 500 cases of LPN. Comparisons were made in patients and preoperative outcomes and peri‐operative complications between SRS group and non‐SRS group. Results Mean warm ischemia time (WIT) in SRS group was less than non‐SRS group (18.0 vs. 24.8 minutes, P=0.021). Renorrhaphy suture cost in SRS group was lower than non‐SRS group ($269.6 vs. $335.8, P=0.001). There were no significant differences between the two groups for postoperative changes in creatinine and estimated glomerular filtration rate and the rate of peri‐operative complications. Conclusion SRS was safe for complex renal tumor with two layers, continuous and unknot suture, during LPN and would reduce the WIT and renorrhaphy suture cost significantly.