CAJ | 학술논문

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.
목적 탐토창면불봉합기술적후복강경하보류신단위수술적림상효과. 방법 2012년12월지2014년2월수치9례신종류환자,남4례,녀5례.년령42～72세,평균56세.종류직경1.1～3.8 cm,평균2.4 cm.종류위우좌측2례,우측7례;위우신중부6례,신하겁2례,신상겁1례.영상학검사시소유종류균명현돌출우신장표면,종류심입신실질0.1 ～ 1.2 cm,균위미침급신집합계통적외주형신종류.전마하행창면불봉합기술후복강경하보류신단위수술,균채용3공법조작.유리신동맥,절제종류주위적지방조직,유리출종류,조단신동맥,연류체변연외0.5 cm처사용전도예성전제종류,사용쌍겁전응대신실질창면진행지혈.개방신동맥,강저기복압력,관찰신실질창면유무출혈,여유출혈,대신실질창면진행봉합,약무출혈표면분쇄의용지혈효. 결과 본조9례수술균순리완성,8례술중미여봉합신실질창면;1례종류교심,쌍겁전응후잉유출혈,행봉합지혈.수술시간90～180 min,평균120 min.신동맥조단시간3～ 18 min,평균8 min.술중출혈량10～200 ml,평균60 ml.무수혈병례.술후균무출혈、루뇨、감염등병발증발생.술후주원시간5～9d,평균7d.소유환자수방3～ 17개월,신공능정상,미견종류복발. 결론 대우체적교소,심입신실질내＜0.5 cm적신종류가이행포면불봉합적후복강경하신부분절제술.
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.