多层螺旋CT血管成像联合术中超声在小肾癌保留肾单位手术中的应用价值  

The application value of ultrasound combined with multi-slice spiral CT angiography in nephron sparing surgury for small renal cancer

作　　者：宋殿宾[1] 徐辉[1] 张晶晶[2] 王志勇[1] 李红阳[1] 迟强[1] 马光[1] 刘英[1] SONG Dianbin;XU Hui;ZHANG Jingjing;WANG Zhiyong;LI Hongyang;CHI Qiang;MA Guang;LIU Ying(Department of Urology,the Affiliated Hospital of Chengde Medical College,Hebei Province,Chengde 067000,China;Department of Oneology,the Affiliated Hospital of Chengde Medical College,Hebei Province,Chengde 067000,China)

机构地区：[1]承德医学院附属医院泌尿外科,河北承德067000 [2]承德医学院附属医院肿瘤科,河北承德067000

出　　处：《中国医药导报》2018年第27期58-61,共4页China Medical Herald

基　　金：河北省承德市科学技术研究与发展计划项目(201701A043)

摘　　要：目的探讨在小肾癌保留肾单位手术(NSS)中应用多层螺旋CT血管成像(MSCTA)联合术中超声的临床价值。方法根据是否行MSCTA联合术中超声将承德医学院附属医院2014年5月～2016年5月65例小肾癌患者分为两组,其中试验组33例,对照组32例。比较两组手术时间、术中出血量、术中热缺血时间、术中微小癌灶发现率、术后拔除肾周引流管时间、术后平均住院日、术后并发症发生率、术后病理切缘阳性率、术肾肾小球滤过率(GFR)。结果肾血管变异在术前MSCTA中与术中所见一致。试验组术中超声发现微小癌灶1例。对照组术后出现漏尿1例。试验组和对照组手术平均时间、术中出血量、术中热缺血平均时间、拔引流管时间、切缘阳性率、术后平均住院日均小于对照组(P<0.05)。试验组患肾GFR手术前后差异无统计学意义(P>0.05),对照组术后患肾GFR较术前显著降低(P<0.05)。结论 MSCTA联合术中超声能够快速地控制肾血管,降低手术风险及术后并发症,同时可最大程度保留肾单位,预后较好,具有较高的临床应用价值。Objective To investigate clinical value of ultrasound combined with multislice spiral CT angiography（MSCTA） in nephron sparing surgery（NSS） for small renal cancer. Methods Based on the usage of ultrasound combined with MSCTA, 65 cases diagnosed with small renal cell carcinoma from May 2014 to May 2016 in the Affiliated Hospital of Chengde Medical College were divided into two groups, experimental group and control group respectively.The experimental group was consisted of 33 cases and the control group included 32 cases. The following indicators were compared between the two groups： operative time, intraoperative blood loss, intraoperative thermal ischemia time,the small lesion detection rate during operation, postoperative time to remove the peritoneal drainage tube, average hospital stay after surgery, postoperative complication rate, positive rate of postoperative pathological margin, postoperative GFR of surgical kidney. Results Intraoperative findings of renal vascular variation rate was consistent with that of preoperative MSCTA. In the experimental group, one case of small lesions was revealed by intraoperative ultrasonography. One case of postoperative urinary leakage occurred in the control group. The operative time, intraoperative blood loss, intraoperative thermal ischemia time, postoperative time to remove the peritoneal drainage tube, positive rate of postoperative pathological margin, average hospital stay after surgery were less in the experimental group than the control group（P〈0.05）. GFR before and after surgery in the experimental group had no statistically significant difference（P〈0.05）.The postoperative GFR of the control group was significantly lower than that before surgery（P〈0.05）. Conclusion MSCTA combined with intraoperative ultrasonography control renal vessels more rapidly and reduce the risk of surgery and postoperative complications. The kidney units can also be retained to the maximum extent. It has good prognosis and great value in clinical application.

关 键 词：小肾癌 保留肾单位手术 多层螺旋CT血管成像 术中超声 

分 类 号：R737[医药卫生—肿瘤]