目的 探讨创面不缝合技术的后腹腔镜下保留肾单位手术的临床效果. 方法 2012年12月至2014年2月收治9例肾肿瘤患者,男4例,女5例.年龄42～72岁,平均56岁.肿瘤直径1.1～3.8 cm,平均2.4 cm.肿瘤位于左侧2例,右侧7例;位于肾中部6例,肾下极2例,肾上极1例.影像学检查示所有肿瘤均明显突出于肾脏表面,肿瘤深入肾实质0.1 ～ 1.2 cm,均为未侵及肾集合系统的外周型肾肿瘤.全麻下行创面不缝合技术后腹腔镜下保留肾单位手术,均采用3孔法操作.游离肾动脉,切除肿瘤周围的脂肪组织,游离出肿瘤,阻断肾动脉,沿瘤体边缘外0.5 cm处使用剪刀锐性剪除肿瘤,使用双极电凝对肾实质创面进行止血.开放肾动脉,降低气腹压力,观察肾实质创面有无出血,如有出血,对肾实质创面进行缝合,若无出血表面喷洒医用止血胶. 结果 本组9例手术均顺利完成,8例术中未予缝合肾实质创面;1例肿瘤较深,双极电凝后仍有出血,行缝合止血.手术时间90～180 min,平均120 min.肾动脉阻断时间3～ 18 min,平均8 min.术中出血量10～200 ml,平均60 ml.无输血病例.术后均无出血、漏尿、感染等并发症发生.术后住院时间5～9d,平均7d.所有患者随访3～ 17个月,肾功能正常,未见肿瘤复发. 结论 对于体积较小,深入肾实质内＜0.5 cm的肾肿瘤可以行刨面不缝合的后腹腔镜下肾部分切除术.%Objective To evaluate the feasibility and clinical efficacy of laparoscopic nephron-sparing surgery without renal wound suturing.Methods From December 2012 to February 2014,9 patients (4 male,5 female) with renal tumor underwent laparoscopic nephron-sparing surgery without suturing in our hospital.The mean age in those patients was 56 years (range 42-72 years).The mass size ranged from 1.1to 3.8 cm (mean 2.4 cm).The location of tumor included 2 in left kidney,7 in right kidney.Meanwhile,6 tumors were found in the middle part of kidney,2 tumors were demonstrated in the lower part of kidney,and 1 tumor located in the upper part of kidney.The imaging examination confirmed that all tumors protruded the renal surface and infiltrated into the renal parenchyma about 0.1-1.2 cm,which could be defined as the peripheral renal tumor without the invasion of collective system.The retroperitoneal approach was used in all patients with 3 trocars.During the operation,the renal artery was exposed and fats surrounding or on the surface of the tumor were resected.The renal artery was occluded.Tumor excision was then performed using scissors.An incision was made at the point 0.5 cm away from the margin of the tumor,extending deeply to completely cut the tumor.Meanwhile,bleeding was controlled with bipolar diathermy.Then,the clamping of the renal artery was removed and the retroperitoneal pressure was reduced in order to check the site of bleeding.If the bleeding occurred severely,the kidney wound was sutured with 2-0 absorbable sutures.Otherwise,the coagulative glue was sprayed on the wound surface.Results In all the patients,the procedures were done without conversion to open surgeries.The renal wound suturing appeared in one case because the tumor infiltrated into the deep of the kidney and the bleeding could not be completely controlled by bipolar diathermy.Eight of 9 cases were successfully performed without suturing.The mean time of renal artery occlusion was 8 min (range 3-18 min).In our patients,the mean operation time was 120 min (90-180 min),and the mean blood loss was 60 ml (10-200 ml).None of the patients received blood transfusion during the surgery.The mean postoperative hospital stay was 7 days (5-9 days).No complications,such as urine leakage,bleeding occurred after the operation.All the patients were followed up with no recurrence of tumor.Conclusions Laparoscopic nephron-sparing surgery without renal wound suturing is feasible and safe for patients with the small and the depth of infiltration less than 0.5 cm tumor in the kidney.
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