Forest Hills Central High School, Grand Rapids, Michigan.
Grand Valley State University, Grand Rapids, Michigan.
J Urol. 2016 Nov;196(5):1560-1565. doi: 10.1016/j.juro.2016.06.093. Epub 2016 Jul 11.
We determined the functional life of various configurations of partial nephrectomy closure systems.
Sutures were prepared using standard techniques for sutured renorrhaphy during partial nephrectomy. Tested systems included knot/Hem-o-Lok®, Lapra-Ty®/Hem-o-Lok and Hem-o-Lok/Hem-o-Lok combinations. The saline filled tank was maintained at 37C. Vicryl®, Stratafix™ polyglycolic acid-polycaprolactone or V-Loc™ 180 sutures were suspended at 4 or 2 N. Suture material breakage or slippage was considered failure.
At 4 N 20% of sutures terminated with knot/Hem-o-Lok failed by 3 weeks compared to 56% and 100% terminated with Lapra-Ty/Hem-o-Lok and Hem-o-Lok/Hem-o-Lok, respectively (p <0.0001). The 55% and 100% of failures with Lapra-Ty/Hem-o-Lok and Hem-o-Lok/Hem-o-Lok, respectively, were generally due to slippage vs 11% with knot/Hem-o-Lok (p <0.0001). Overall failure rates with Lapra-Ty/Hem-o-Lok for zero to 4-zero sutures were 41% with Vicryl, 82% with polyglycolic acid-polycaprolactone and 24% with V-Loc 180 (p <0.0001). The only sutures without failure at 4 N with Lapra-Ty/Hem-o-Lok and knot/Hem-o-Lok closure systems were Vicryl zero, and V-Loc 2-zero and 3-zero. At 2 N Lapra-Ty/Hem-o-Lok failure (17.5% vs 0%, p = 0.039) and Hem-o-Lok/Hem-o-Lok failure (39% vs 16%, p = 0.074) were more common with polyglycolic acid-polycaprolactone than with V-Loc sutures.
Hem-o-Lok/Hem-o-Lok and Lapra-Ty/Hem-o-Lok combinations resulted in more frequent failures at 3 weeks or greater than knot/Hem-o-Lok. For all sutures tested knots were superior to Lapra-Tys to backstop Hem-o-Loks at 4 N. Preferably, Vicryl zero or V-Loc 2-zero/3-zero sutures should be used in combination with knots or Lapra-Tys at 4 N. Under these experimental conditions the Lapra-Ty/Hem-o-Lok combination did not reliably suspend the other sutures tested for 3 weeks. If Lapra-Ty/Hem-o-Lok or Hem-o-Lok/Hem-o-Lok combinations are used, we recommend closure at lesser tension and/or the use of appropriate sutures.
我们确定了各种部分肾切除术闭合系统的功能寿命。
使用标准技术为部分肾切除术的缝合肾再吻合制备缝线。测试的系统包括结/Hem-o-Lok®、Lapra-Ty®/Hem-o-Lok 和 Hem-o-Lok/Hem-o-Lok 组合。盐水填充罐保持在 37°C。Vicryl®、Stratafix™聚乙二醇酸-聚己内酯或 V-Loc™180 缝线在 4 或 2 N 处悬挂。缝线材料断裂或滑动被认为是失效。
在 4 N 时，用结/Hem-o-Lok 封闭的 20%缝线在 3 周内失效，而用 Lapra-Ty/Hem-o-Lok 和 Hem-o-Lok/Hem-o-Lok 封闭的缝线分别有 56%和 100%失效（p<0.0001）。Lapra-Ty/Hem-o-Lok 和 Hem-o-Lok/Hem-o-Lok 失效的 55%和 100%通常是由于滑动，而用结/Hem-o-Lok 失效的 11%（p<0.0001）。Lapra-Ty/Hem-o-Lok 用于零到 4 零缝线的总失效率分别为 Vicryl 的 41%、聚乙二醇酸-聚己内酯的 82%和 V-Loc 180 的 24%（p<0.0001）。Lapra-Ty/Hem-o-Lok 和结/Hem-o-Lok 闭合系统中，在 4 N 时没有失效的缝线只有 Vicryl 零、V-Loc 2 零和 3 零。在 2 N 时，Lapra-Ty/Hem-o-Lok 的失效（17.5%比 0%，p=0.039）和 Hem-o-Lok/Hem-o-Lok 的失效（39%比 16%，p=0.074）比 V-Loc 缝线更常见。
Hem-o-Lok/Hem-o-Lok 和 Lapra-Ty/Hem-o-Lok 组合在 3 周或更长时间后导致比结/Hem-o-Lok 更频繁的失效。对于所有测试的缝线，在 4 N 时，结优于 Lapra-Ty 以阻止 Hem-o-Lok 失效。在 4 N 时，最好使用 Vicryl 零或 V-Loc 2 零/3 零缝线与结或 Lapra-Ty 联合使用。在这些实验条件下，Lapra-Ty/Hem-o-Lok 组合不能可靠地悬挂测试的其他缝线 3 周。如果使用 Lapra-Ty/Hem-o-Lok 或 Hem-o-Lok/Hem-o-Lok 组合，我们建议减少张力闭合和/或使用适当的缝线。
