后腹腔镜阻断副肾动脉肾部分切除中应用MSCTA及术中超声的效果观察  

Observation of Effect of MSCTA and Intraoperative Ultrasound in Partial Nephrectomy with Retroperitoneal Laparoscopic Occlusion of Accessory Renal Artery

作　　者：宋殿宾[1] 毕海 张晶晶[1] 马光[1] 李红阳[1] 刘英[1] 王志勇[1] SONG Dianbin(Affiliated Hospital of Chengde Medical University,Hebei Chengde 067000,China)

机构地区：[1]承德医学院附属医院,河北承德067000 [2]北京大学第三医院泌尿外科,北京100000

出　　处：《河北医学》2019年第9期1549-1552,共4页Hebei Medicine

基　　金：河北省承德市科学技术研究与发展计划项目,(编号:201701A043)

摘　　要：目的:探讨后腹腔镜阻断副肾动脉肾部分切除术(LPN)应用术前多层螺旋CT血管成像(MSCTA)及术中超声的效果观察。方法:根据是否行MSCTA及术中超声,回顾承德医学院附属医院2014年5月至2017年5月45例小肾癌患者,将其分为两组,其中研究组23例,对照组22例。比较两组相关数据,包括出血量、手术时间、术中热缺血时间、微小癌灶发现率、中转开放率、术后漏尿、切缘阳性率、术肾GFR测定。结果:研究组和对照组的手术时间分别为115±5.0min和132±4.8min,术中出血量分别平均为80±3.0mL和108±3.8mL,术中热缺血时间分别平均为25±2.2min和32±2.6min,中转开放手术例数分别为1例(4.3%)和3例(13.6%)。差异均具有统计学意义(P<0.05)。微小癌灶发现例数分别为1例和0例。术后漏尿例数分别为0例和1例。切缘阳性例数分别为0和1例,研究组术前、术后患肾GFR分别为57.1±7.2mL/min和56.1±7.7mL/min(P>0.05),对照组术前、术后患肾GFR分别为57.8±7.0mL/min和53.4±6.5mL/min(P<0.05)。结论:MSCTA能够术前发现肿瘤供应的副肾动脉,并指导术中及时准确的控制,减少出血量,同时术中超声可以快速准确的定位肿瘤组织,尽可能的保留肾单位,减少切缘阳性率,并有利于术后患肾功能的恢复。Objective:To investigate the effect of preoperative multi-slice spiral CT angiography(MSCTA)and intraoperative ultrasound on laparoscopic obstruction of renal artery partial nephrectomy(LPN).Methods:According to whether MSCTA and intraoperative ultrasound were performed,45 cases of small renal cell carcinoma from May 2014 to May 2017 in the Affiliated Hospital of Chengde Medical College were retrospectively reviewed.They were divided into two groups,23 cases in the study group and 22 cases in the control group.Relevant data were compared between the two groups,including bleeding volume,operation time,intraoperative warm ischemia time,detection rate of microcarcinoma,conversion and opening rate,leakage of urine after operation,positive rate of incision margin,and determination of GFR in operation kidney.Results:The research group and the control group operation time was 115±5.0min and 132±4.8 min,respectively.The intraoperative blood loss was 80±3.0 ml and 108±3.8 ml,respectively.The mean time was 25±2.2 min and 32±2.6 min,respectively,The number of cases of open surgery was 1 and 3,respectively.and the difference was statistically significant(p<0.05).The number of cases of microscopic cancer lesions was 1 and 0,respectively.The number of cases of postoperative leakage was 0 and 1 respectively.The number of positive margins was 0 and 1 respectively.The preoperative and postoperative renal GFR of the research group were 57.1±7.2 ml/min and 56.1±7.7 ml/min(P>0.05),respectively.Renal GFR was 57.8±7.0 ml/min and 53.4±6.5 ml/min(P<0.05),respectively.Conclusion:MSCTA can detect the accessory renal artery provided by the tumor before operation,and guide the timely and accurate control during operation to reduce the amount of bleeding.At the same time,intraoperative ultrasound can quickly and accurately locate the tumor tissue,preserve the nephron as much as possible,and reduce the positive margin of the margin.And is conducive to the recovery of renal function after surgery.

关 键 词：LPN 阻断副肾动脉 MSCTA 术中超声 

分 类 号：R73[医药卫生—肿瘤]