CAJ | 학술논문

目的研究V-loc缝线在保留肾单位手术中应用的安全性. 方法 2010年8月针对V-1oc缝线进行了系列研究:①利用测力器和离体猪肾对比研究间断缝合、水平褥式缝合下V-loc缝线和Hem-o-lok的组织抓持力；②利用球囊扩张对比研究V-loc缝线和Hem-o-lok无结法关闭离体猪肾后的抗膨胀能力；③利用活体猪肾部分切除术验证V-loc缝线能否有效完成肾脏缺损重建.结果在离体猪肾模型中,间断缝合时4-0和2-0 V-loc缝线和单Hem-o-lok对肾脏组织的抓持力分别为1.62、2.52和3.26 N,而2个Hem-o-lok的组织抓持力可增加到4.10 N.在水平褥式缝合中,2-0V-Loc缝线和单Hem-o-lok均能有效地抓持组织,但当牵拉力量增大到一定程度,缝线和Hem-o-lok均会对肾脏组织产生切割效应.球囊扩张试验中(30个大气压),Hem-o-lok组能有效地关闭肾脏,V-loc缝线组的肾脏创面被部分撑开,并有多处切割痕迹出现.活体动物实验中,V-loc缝线能有效关闭肾脏缺损,切割处小的出血经短时压迫后均可停止. 结论尽管V-loc缝线对组织的抓持力不及Hem-o-lok,且有切割肾组织的风险,但在活体动物实验中能够有效关闭肾脏缺损并减少热缺血时间,值得在临床工作中验证其安全性.
목적 연구V-loc봉선재보류신단위수술중응용적안전성. 방법 2010년8월침대V-1oc봉선진행료계렬연구:①이용측력기화리체저신대비연구간단봉합、수평욕식봉합하V-loc봉선화Hem-o-lok적조직조지력；②이용구낭확장대비연구V-loc봉선화Hem-o-lok무결법관폐리체저신후적항팽창능력；③이용활체저신부분절제술험증V-loc봉선능부유효완성신장결손중건.결과 재리체저신모형중,간단봉합시4-0화2-0 V-loc봉선화단Hem-o-lok대신장조직적조지력분별위1.62、2.52화3.26 N,이2개Hem-o-lok적조직조지력가증가도4.10 N.재수평욕식봉합중,2-0V-Loc봉선화단Hem-o-lok균능유효지조지조직,단당견랍역량증대도일정정도,봉선화Hem-o-lok균회대신장조직산생절할효응.구낭확장시험중(30개대기압),Hem-o-lok조능유효지관폐신장,V-loc봉선조적신장창면피부분탱개,병유다처절할흔적출현.활체동물실험중,V-loc봉선능유효관폐신장결손,절할처소적출혈경단시압박후균가정지. 결론 진관V-loc봉선대조직적조지력불급Hem-o-lok,차유절할신조직적풍험,단재활체동물실험중능구유효관폐신장결손병감소열결혈시간,치득재림상공작중험증기안전성.
Objective To compare anchoring capabilities and holding strength of Hem-o-lok clips and barbed sutures on porcine renal parenchyma.Methods An ex-vivo model was used for the study by using fresh porcine kidneys with intact renal capsule.A longitudinal incision was made on the renal capsule and parenchyma to a depth of 0.5 cm.The following sutures were tested:a 2-0 Vicryl (Covidien) with one and two Hem-o-lok clips (Weck),2-0 V-loc (Covidien),and 4-0 V-loc.An interrupted suture was placed through the renal capsule and parenchyma and attached to a hand-held force tester to quantify the holding strength.The tearing strength was also measured with the force tester using a horizontal mattress suture of 2-0 V-loc and 2-0 Vicryl secured with one Hem-o-lok clip (suture passing either through the middle or the far edge of the clip).Then,a Nephromax balloon catheter (Boston Scientific) was placed into the parenchymal incision,which was closed by a horizontal mattress suture with "sliding-clip technique" or by using a V-loc suture.The balloon was dilated and the incision of renal parenchyma was observed.Every procedure was repeated five times.Finally,the laparoscopy partial nephrectomy was performed with 2-0 V-loc suture in the living porcine model.Results The mean forces required for suture slippage are 2.52 N (2-0 V-loc suture ),3.26 N (2-0 Vicryl suture with one Hem-o-lok clip) and 4.10 N (2-0 Vicryl suture with two Hem-o-lok clips).And in the 2-0 V-loc suture group,the forces to violate the renal capsule was lower than in the two Hem-o-lok clips group.Unlike the renorrhaphy using the sliding clip technique,the horizontal mattress closure with the V-loc suture had withstand balloon dilation.However,in the living animal lab,the V-loc suture can facilitate renorrhaphy safely during partial nephrectomy.Conclusions The V-loc barbed suture can provide a similar holding strength with the same size Vicryl suture with one Weck clip anchor.However,we need more study to show enough safety due to the tissue tearing effect.