摘要/Abstract
摘要： 目的·探讨应用氩气刀免缝合技术在腹腔镜下肾部分切除术中的安全性及可行性。方法·选取2016年10月至2017年10月期间在上海交通大学医学院附属第九人民医院应用氩气刀免缝合技术完成腹腔镜肾部分切除术的10例患者。回顾性分析该手术方式的临床疗效及安全性。结果·选取的10例患者平均年龄50.4（24.0～73.0）岁，肿瘤平均大小2.1（1.5～2.5）cm，平均RENAL评分5分。10例患者全部行术中肾动脉阻断。术中使用剪刀将肿瘤完整切除，切除后的肿瘤床，使用氩气刀反复喷凝止血，待凝血充分后用止血纱布覆盖肿瘤床表面。平均手术时间95.0（60.0～108.0）min，肾动脉阻断平均热缺血时间7.8（5.5～10.0）min。术中平均失血量86（50～150）mL。术后第1日血红蛋白平均下降量11.8（3.0～22.0）g/L。平均留置导尿时间2.7（1.5～3.5）d，平均住院时间5.2（4.0～7.0）d，术后负压引流管拔出时间2.6（1.0～4.0）d，引流量38.5（10.0～80.0）mL。结论·使用氩气刀喷凝止血对肾肿瘤患者行肾部分切除术具有良好的疗效和安全性，尤其针对一些外生型肾脏肿瘤，手术时间短，热缺血损伤轻，术后效果好，并未增加患者术后住院时间，可减轻患者经济负担，值得推广应用。
关键词: 肾肿瘤, 肾部分切除术, 氩气刀, 免缝合
Abstract:
Objective · To explore the safety and feasibility of using sutureless technique of argon beam coagulator in laparoscopic partial nephrectomy. Methods · A total of 10 patients receiving laparoscopic partial nephrectomy with argon beam coagulator in Shanghai Ninth Peoples Hospital, Shanghai Jiao Tong University School of Medicine October 2016 to October 2017 were selected. The clinical efficacy and safety of the operation was retrospectively analyzed. Results · The average age of the 10 patients was 50.4 (24.0-73.0)years, the average size of the tumor was 2.1 (1.5-2.5)cm, and the average RENAL score was 5. All of the 10 patients underwent intraoperative renal artery occlusion. Intraoperative scissors were used to completely remove the tumor and remove the tumor bed after the resection. Then the argon beam coagulator was repeatedly used for hemostasis. After hemostasis was completed, the hemostatic gauze was covered on the surface of the tumor bed. The mean operation time was 95.0 (60.0-108.0) min, and the average thermal ischemia time of the renal artery occlusion was 7.8 (5.5-10.0) min. The average blood loss was 86 (50-150) mL during the operation. The average decrease of hemoglobin was 11.8 (3.0-22.0) g/L on the first day after operation. The mean indwelling catheterization time was 2.7 (1.5-3.5)d, the average time of hospitalization was 5.2 (4.0-7.0) d, the extraction time of drainage tube after operation was 2.6(1.0-4.0) d, and the flow rate was 38.5 (10.0-80.0) mL. Conclusion · Argon knifes pray coagulation has good efficacy and safety in patients with renal tumor renal resection, especially for some exophytic renal tumors, which has short operation time, less damage of hot ischemia, good postoperative effect, no increase in hospitalization time after surgery, reduced economic burden of the patients, being worthy of popularization and application.
Key words: renal tumor, partial nephrectomy, argon beam coagulator, sutureless
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