腹腔镜超声在肾部分切除术治疗肾门旁中央型小肾癌中的临床价值  

Clinical value of laparoscopic ultrasonography in assisting laparoscopic partial nephrectomy for centrally located para-hilus renal tumors

作　　者：任巨超[1] 李明宝[1] 刘焕银 房志卿[1] 闫磊[1] 徐忠华[1] 

机构地区：[1]山东大学齐鲁医院泌尿外科,山东济南250012 [2]聊城市复退军人医院外二科,山东聊城252000

出　　处：《山东大学学报（医学版）》2015年第3期77-80,86,共5页Journal of Shandong University:Health Sciences

基　　金：国家自然科学基金面上项目(81372335);国家自然基金青年基金(81402108);山东省优秀中青年科学家科研奖励基金(BS2014SW015)

摘　　要：目的探讨腹腔镜超声(LUS)辅助下经腹腔及后腹腔腹腔镜肾部分切除术(LPN)治疗肾门旁中央型肾癌的临床应用价值。方法分析2014年3月至7月收治行LUS辅助下LPN治疗的4例肾门旁中央型小肾癌患者的临床资料,其中2例经腹腔手术入路、2例经后腹腔手术入路,并记录分析手术时间、出血量、术后病理报告及切缘情况。结果 LUS术中示肾癌形态欠规则,边界清,内部回声不均匀,肿瘤内部或周边可探及血流信号,并能显示与集合系统及血管的位置关系,明显优于术前常规超声检查,有助于确定肾肿瘤切除的范围。术后病理证实肾透明细胞癌4例,且所有切缘均阴性。结论 LUS在术中可以动态监测肿瘤位置及其与肾集合系统、肾门血管的位置关系,有助于尽可能保留肾单位,避免集合系统与肾血管的损伤,减少出血量及保证切缘阴性具有重要的临床应用价值。Objective To evaluate the applicative value of intra-operative laparoscopic ultrasonography（ LUS） in laparoscopic partial nephrectomy（ LPN） of centrally located para-hilus renal tumors. Methods Clinical date of 4 patients who underwent LPN for centrally located renal tumors with LUS in our hospital during March to July of 2014 were retrospectively analyzed. Two of the patients were operated through abdominal cavity and 2 were operated through retroperitoneum. Indicators such as operation time,blood loss,pathology,incisal margin and so on were assessed. Results LUS showed that malignant renal tumors displayed irregular shape,clear boundary and inhomogeneous echo. Color Doppler ultrasonography showed blood flowwithin or around the tumors,which provided more information than normal ultrasonography before operation and helped to determine the scope of the renal tumor resection. All cases were confirmed renal cell carcinoma and negative margin with postoperative pathology. Conclusion It is of high clinical value to use LUS in LPN for centrally located renal tumors with real-time image,which helps surgeons to determine the location of the tumor and the position relation between the tumor and vessels and the collection system. At the same time,it also helps to reduce intra-operative hemorrhage,provide negative incisal margin and guarantee the safety of operation.

关 键 词：中央型肾肿瘤 腹腔镜超声 肾部分切除术 切缘 

分 类 号：R699.2[医药卫生—泌尿科学]