Baumert Hervé, Ballaro Andrew, Shah Nimish, Mansouri Dhouha, Zafar Nauman, Molinié Vincent, Neal David
Department of Urology, Paris Saint Joseph Hospital Trust, Paris, France.
Eur Urol. 2007 Oct;52(4):1164-9. doi: 10.1016/j.eururo.2007.03.060. Epub 2007 Mar 28.
To test the hypothesis that a modified technique for renal parenchymal closure during laparoscopic partial nephrectomy (LPN) enables a significant reduction in warm ischaemia (WIT).
Perioperative factors including WIT were prospectively recorded during 40 consecutive LPNs performed by a single experienced laparoscopist. In the first 20 (controls), renal parenchyma was closed by conventional technique (haemostasis and closure of the collecting system with interrupted sutures, then closure of the renal parenchyma over a Surgicel bolster before unclamping the renal artery). In the second consecutive 20 patients (group 1), a modified closure technique was used, which involved earlier arterial unclamping after two (group 1a) or one (group 1b) running suture on the tumour bed. Vascularised renal parenchyma was then closed over a surgical bolster.
All LPNs were performed successfully without conversion. WIT was significantly less in group 1 compared with the control group (27.2+/-5 min vs. 13.7+/-4 min, respectively; p<0.01). WIT was 16.8+/-3.6 vs. 10.3+/-1.2 min in groups 1a and 1b (p<0.01); no other significant differences were observed in perioperative factors. All specimens had negative tumour margins histologically. Major complications and haemoglobin reduction were lower in group 1 compared with the control group.
The described technique is effective and allows a significant reduction of WIT, even in challenging cases, without increasing perioperative bleeding or morbidity. Its use therefore reduces the need for hypothermic techniques, and allows more time for careful tumour resection and renal reconstruction.
验证如下假设，即在腹腔镜肾部分切除术（LPN）期间采用改良的肾实质闭合技术可显著减少热缺血时间（WIT）。
由一名经验丰富的腹腔镜医师连续进行40例LPN手术，前瞻性记录包括WIT在内的围手术期因素。在前20例（对照组）中，采用传统技术闭合肾实质（用间断缝线止血并闭合集合系统，然后在松开肾动脉前在一块外科止血棉垫上闭合肾实质）。在接下来连续的20例患者（第1组）中，采用改良的闭合技术，即在肿瘤床进行两针（第1a组）或一针（第1b组）连续缝合后更早松开动脉。然后在一块外科棉垫上闭合带血管的肾实质。
所有LPN手术均成功完成，无中转开腹。与对照组相比，第1组的WIT显著缩短（分别为27.2±5分钟和13.7±4分钟；p<0.01）。第1a组和第1b组的WIT分别为16.8±3.6分钟和10.3±1.2分钟（p<0.01）；围手术期因素未观察到其他显著差异。所有标本的肿瘤边缘组织学检查均为阴性。与对照组相比，第1组的主要并发症和血红蛋白降低情况较少。
所描述的技术有效，即使在具有挑战性的病例中也能显著减少WIT，且不增加围手术期出血或发病率。因此，该技术的应用减少了对低温技术的需求，并为仔细进行肿瘤切除和肾脏重建留出了更多时间。
