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首页> 外文期刊>Urologic oncology >Fibrin glue v sutured bolster: Lessons learned during 100 laparoscopic partial nephrectomies Johnston WK III, Montgomery JS, Seifman BD, Hollenbeck BK, Wolf SJ Jr, Michigan Urology Center, University of Michigan, Ann Arbor, MI.
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Fibrin glue v sutured bolster: Lessons learned during 100 laparoscopic partial nephrectomies Johnston WK III, Montgomery JS, Seifman BD, Hollenbeck BK, Wolf SJ Jr, Michigan Urology Center, University of Michigan, Ann Arbor, MI.

机译：纤维蛋白胶v缝合的枕垫：在100例腹腔镜部分肾切除术中吸取的教训Johnston WK III，Montgomery JS，Seifman BD，Hollenbeck BK，Wolf SJ Jr，密歇根大学密歇根大学泌尿学中心，密西根州安娜堡市。

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PURPOSE: Laparoscopic partial nephrectomy (LPN) is performed with marked technical variations. We defined the limits of sutureless LPN and determined which closure technique is best in a particular situation. MATERIALS AND METHODS: During 100 consecutive LPNs fibrin glue products were used for closure in the first 75 (group 1) and sutured bolsters were applied when the collecting system (CS) or renal sinus was entered in the final 25 (group 2). RESULTS: In groups 1 and 2 hand assisted laparoscopy was used in 72% vs 40% of cases and hilar clamping was used in 27% vs 92%, respectively. Mean tumor size was 25 vs 26 mm, tumor depth was 11 vs 13 mm, distance to the renal sinus was 9 vs 5 mm, operating room time was 185 vs 210 minutes, estimated blood loss was 398 vs 247 cc and hospital stay was 2.9 vs 2.6 days in groups 1 and 2, respectively. Overall postoperative hemorrhage and urine leakage occurred in 9% and 2% of patients, respectively. Tumors associated with postoperative hemorrhage/leakage tended to be larger (35 vs 24 mm, p = 0.007) and closer to the renal sinus (0.5 vs 8.2 mm, p = 0.02). Postoperative hemorrhage or urine leakage occurred in 41% of the 17 patients in group 1 with CS or renal sinus entry but in only 2 of the 58 (3.4%) without entry (p <0.0001). In group 2 hemorrhage/leakage occurred in 11% of the 18 patients with CS or renal sinus entry (vs same subset in group 1, p = 0.04). CONCLUSIONS: LPN with closure using fibrin glue products provides adequate hemostasis when the CS or renal sinus is not entered. When the CS or renal sinus is entered, a sutured bolster is recommended.
机译：目的：进行腹腔镜部分肾切除术（LPN），技术上有显着差异。我们定义了无缝合LPN的限制，并确定在特定情况下哪种闭合技术最佳。材料与方法：在前75个（组1）中使用100个连续的LPNs纤维蛋白胶产品封闭，在最后25个（组2）中输入收集系统（CS）或肾窦时使用缝合的支撑。结果：在第1组和第2组中，分别有72％和40％的病例采用了手助腹腔镜检查，分别有27％和92％的患者采用了肺门钳夹术。平均肿瘤大小为25 vs 26 mm，肿瘤深度为11 vs 13 mm，距肾窦的距离为9 vs 5 mm，手术室时间为185 vs 210分钟，估计失血量为398 vs 247 cc，住院时间为2.9与第1组和第2组的2.6天相比。术后总出血量和尿液渗漏分别发生在9％和2％的患者中。与术后出血/渗漏相关的肿瘤往往更大（35 vs 24 mm，p = 0.007），并且更接近肾脏窦（0.5 vs 8.2 mm，p = 0.02）。第1组CS或肾窦入路的17例患者中有41％发生术后出血或尿液渗漏，但58例中无入路的仅有2例（3.4％）发生（p <0.0001）。在第2组中，有18名CS或肾窦入路患者中有11％发生了出血/渗漏（与第1组中的相同子集相比，p = 0.04）。结论：当未输入CS或肾窦时，使用纤维蛋白胶产品封闭的LPN可提供足够的止血作用。当输入CS或肾窦时，建议使用缝合的枕垫。

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