Paka Bikal, Bossemeyer Robert, Tourojman Mouafak, Gupta Ruchir, Lane Brian R
Grand Valley State University, Grand Rapids, MI.
Urology, Spectrum Health, Grand Rapids, MI.
Urology. 2017 Sep;107:138-143. doi: 10.1016/j.urology.2017.06.024. Epub 2017 Jun 23.
To investigate the anti-slip strength of closing systems employing sutures terminated with a Hem-o-lok/Lapra-Ty clip combination to determine which sutures perform best for this application. Partial nephrectomy is the reference standard for treatment of small renal masses. The main disadvantage of partial nephrectomy is the risk of technical complications, including renorrhaphy site bleeding and urine leak.
A materials testing system produced a constant velocity pull on the free end of an anchored suture. A Lapra-Ty clip was attached 1 cm from the end of each suture as a backstop for the Hem-o-lok. A digital force gauge measured the tension that was applied until the suture slipped in the closing system. Vicryl, Monocryl, Chromic, Stratafix, and V-Loc sutures of diameters 1 to 4-0 were tested (n = 7 for each suture type, 161 total experiments).
The holding strength of a Lapra-Ty/Hem-o-lok clip combination is lowest for Vicryl 4-0 (4.3 ± 1.4N) and highest for Monocryl 0 (16.5 ± 1.6N) sutures. Larger sutures (1 and 0) hold at higher tensions than sutures with smaller dimensions (4-0 and 3-0). For 2-0 sutures, the holding strength was 5.7N with Vicryl, 13.8N with Stratafix, and 15.9N with V-Loc sutures.
The mean values of holding tension of this anchoring system for all sutures tested was greater than the amount found to be sufficient for tissue closure in previous studies (3.2N). Barbed sutures (Stratafix, V-Loc) appeared to have superior holding strength when compared with most standard sutures; barb orientation does not influence holding tension.
研究采用Hem-o-lok/Lapra-Ty夹组合终止缝合线的闭合系统的防滑强度，以确定哪种缝合线在此应用中表现最佳。部分肾切除术是治疗小肾肿块的参考标准。部分肾切除术的主要缺点是存在技术并发症的风险，包括肾缝合部位出血和尿漏。
材料测试系统对固定缝合线的自由端施加恒定速度的拉力。在每条缝合线末端1厘米处连接一个Lapra-Ty夹，作为Hem-o-lok的挡块。数字测力计测量施加的张力，直到缝合线在闭合系统中滑动。测试了直径为1至4-0的薇乔（Vicryl）、爱惜康单股（Monocryl）、铬制（Chromic）、史迪菲克斯（Stratafix）和V-Loc缝合线（每种缝合线类型n = 7条，共161次实验）。
Lapra-Ty/Hem-o-lok夹组合的夹持强度对于4-0薇乔缝合线最低（4.3±1.4N），对于0号爱惜康单股缝合线最高（16.5±1.6N）。较大尺寸的缝合线（1号和0号）比小尺寸的缝合线（4-0号和3-0号）能承受更高的张力。对于2-0号缝合线，薇乔缝合线的夹持强度为5.7N，史迪菲克斯缝合线为13.8N，V-Loc缝合线为为15.9N。
该锚固系统对所有测试缝合线的平均夹持张力值大于先前研究中发现的足以实现组织闭合的数值（3.2N）。与大多数标准缝合线相比，倒刺缝合线（史迪菲克斯、V-Loc）似乎具有更高的夹持强度；倒刺方向不影响夹持张力。
