术中超声及术前辅助多层螺旋CT血管成像在阻断副肾动脉保肾手术中的效果观察  

The effect of intraoperative ultrasound and preoperative assisted MSCTA in nephron sparing surgery by temporary accessory renal artery occlusion

作　　者：宋殿宾[1] 王志勇[1] 毕海 张晶晶[3] 马光[1] 李红阳[1] 刘英[1] SONG Dianbin;WANG Zhiyong;BI Hai;ZHANG Jingjing;MA Guang;LI Hongyang;LIU Ying(Department of Urology,the Affiliated Hospital of Chengde Medical University,Chengde,Hebei Province 067000,China;Department of Urology,Peking University Third Hospital,Beijing 10000,China;Department of Oncology,the Affliated Hospital of Chengde Medical University,Chengde,Hebei Province 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]北京大学第三医院泌尿外科,北京100000 [3]承德医学院附属医院肿瘤科,河北承德067000

出　　处：《实用放射学杂志》2020年第8期1269-1272,共4页Journal of Practical Radiology

基　　金：承德市科学技术研究与发展计划项目(201701A043).

摘　　要：目的探讨术中超声及术前辅助多层螺旋CT血管成像(MSCTA)在后腹腔镜阻断副肾动脉保肾手术中的应用价值.方法回顾性分析62例小肾癌患者资料,术前常规行MSCTA检查,将行阻断副肾动脉及术中超声列为研究组,将全阻断肾动脉列为对照组.2组各31例患者.比较2组手术时间、出血量、术中热缺血时间、微小癌灶发现率、中转开放率、术后肠道功能恢复时间、术后住院时间、术后漏尿、切缘阳性率、术后患肾肾小球滤过率(GFR)测定情况.结果62例患者术前MSCTA检查显示血管情况与术中所见一致.研究组中手术时间、出血量、术中热缺血时间、中转开放率、术后肠道功能恢复时间、术后住院时间、术后漏尿、切缘阳性率均优于对照组,差异有统计学意义(P<0.05).同时研究组术中超声发现微小癌灶1例.研究组术前、术后患肾GFR分别为(54.1±7.2)mL/min和(53.1±7.7)mL/min(P>0.05),而对照组术前、术后患肾GFR分别为(55.8±7.0)mL/min和(39.4±6.5)mL/min(P<0.05).结论术中超声联合术前辅助MSCTA在后腹腔镜阻断副肾动脉保留肾单位手术中有一定的安全性,能够术前发现供应肿瘤的副肾动脉,指导术中及时准确地控制,同时减少了正常残余肾组织的热缺血,有利于术后残肾功能的恢复.Objective To evaluate the value of intraoperative ultrasound and preoperative MSCTA in accessory renal artery obstruction and renal artery preservation by posterior laparoscopy.Methods A retrospetive study of 62 patients with small renal cell carcinoma underwent routine MSCTA examination before operation.Experimental group included 31 patients underwent nephron sparing surgery(NSS)by temporary accessory renel artery occlusion and intraoperative ultrasound。control group included ohter 31 patients underwent NSS by temporary fully renal artery occlusion.Operation time,blood loss,intraoperative warm ischemia time,microscopic cancer discovery rate,transit opening rate,postoperative intestinal function recovery time。postoperative hospital stay。postoperative leakage of urine,positive mar-gin of cutting margin,surgery postoperative renal GFR were measured.Results Preoperative MSCTA examination of 62 patients showed that the vascular condition was consistent with that seen during surgery.The operation time,blood loss,intraoperative warm ischemia time,transit opening rate,postoperative intestinal function recovery time,postoperative hospital stay,postoperative leakage of urine and positive margin of cutting margin of the experimental group were significantly superior to the control group(P<0.05).Meanwhile,1 case of microscopic cancer was found by intraoperative ultrasound in the experimental group.The preoperative and postoperative renal GFR of the experimental group were(54.1±7.2)mL/min and(53.1±77)mL/min,respectively(P>0.05),while the control group had preoperative and postoperative renal GFR of(55.8±7.0)mL/min and(39.4±6.5)mL/min(P<0.05).Conclusion Intraoperative ultrasound combined with preoperative MSCTA hascertain safety in the operation of posterior laparoscopy NSS by temporary accessory renal artery occlusion.It can detect the accessory renal artery supplying the tumor before operation and control timely and accurately during the operation.It reducing warm ischemia of normal residual renal tissue and is c

关 键 词：小肾癌 阻断副肾动脉 后腹腔镜保留肾单位手术 计算机体层成像 血管造影术 术中超声 

分 类 号：R737.11[医药卫生—肿瘤] R814.42[医药卫生—临床医学]