腹腔镜超声在泌尿外科达芬奇机器人手术中的应用价值  

The Application Value of Laparoscopic Ultrasound in Da Vinci Robotic Surgery of Urology

作　　者：张君 桑林 张龙龙 周惠惠 刘丽娜 杨晓剑 于铭 Zhang Jun;Sang Lin;Zhang Longlong;Zhou Huihui;Liu Li′na;Yang Xiaojian;Yu Ming(Department of Medical Ultrasonic,the First Affiliated Hospital of Air Force Medical University,Xi'an,Shanxi 710032,China)

机构地区：[1]空军军医大学第一附属医院超声医学科,西安市710032 [2]空军军医大学第一附属医院泌尿外科,西安市710032

出　　处：《中国超声医学杂志》2020年第10期911-916,共6页Chinese Journal of Ultrasound in Medicine

摘　　要：目的探讨术中腹腔镜超声在泌尿外科达芬奇机器人手术中的应用价值。方法回顾性分析我院收治的30例行达芬奇机器人辅助腹腔镜手术并于术中联合使用腹腔镜超声(LUS)患者的临床资料,其中,内生性肾肿瘤21例,行LUS定位机器人辅助腹腔镜肾肿瘤剜出术;肾肿瘤合并下腔静脉癌栓9例,行LUS定位机器人辅助腹腔镜肾肿瘤根治+下腔静脉癌栓取出术;并对比分析17例内生性恶性肾肿瘤的术前经腹超声检查以及术中LUS探查的肿瘤影像学特征。结果30例患者手术均顺利完成,术中应用LUS对肿瘤边界以及下腔静脉癌栓进行了准确定位。其中,肾肿瘤剜出术的患者平均手术时间约155.5 min,术中平均出血量约47.37 ml,平均住院时间为7.6 d,术后病理结果:17例为恶性肿瘤,切缘均为阴性,4例为良性病变,术后随访3~36个月,未发现复发及转移。肾肿瘤根治+下腔静脉癌栓取出术的患者平均手术时间约406.1 min,术中平均出血量约677.78 ml,平均住院时间为12.5 d,术后病理结果:9例均为恶性肿瘤,术后随访3~12个月,2例患者出现肝脏转移。术中LUS探查对内生性恶性肾肿瘤的边界及内部血流信息的显示优于术前经腹超声检查。结论达芬奇机器人手术术中联合应用LUS可在泌尿外科肾肿瘤手术中准确定位肿瘤边界及癌栓范围,为手术的安全、顺利进行提供有效保障。Objective To discuss the application value of laparoscopic ultrasound in Da Vinci robotic assisted laparoscopic surgery of urology.Methods A retrospective analysis on the clinical data of 30 cases subject to Da Vinci robotic assisted laparoscopic surgery and in combination with laparoscopic ultrasound in xijing hospital,and the imaging characteristics(the boundary,shape,internal echo and color doppler of the tumor,etc.)of 17 cases endogenous malignant renal tumors by preoperative routine abdominal ultrasound examination and intraoperative laparoscopic ultrasound were analyzed.Results All 30 patients were performed successfully with robotic-assisted laparoscopic surgery.During the surgery,laparoscopic ultrasound was used to accurately locate the tumor boundary and the inferior vena cava(IVC)tumor thrombus.The results of intraoperative laparoscopic ultrasound in 17 cases of endogenous malignant renal tumors showed significantly better boundary and internal blood flow information than that of preoperative routine abdominal ultrasound.Conclusions The combined application of laparoscopic ultrasound in Da Vinci robotic-assisted surgery can accurately locate the boundary of tumor and the scope of the tumor thrombus in renal tumor surgery,and provide an effective guarantee for the safe and smooth operation.

关 键 词：腹腔镜超声 机器人辅助腹腔镜手术 肾肿瘤剜除术 癌栓取出术 

分 类 号：R699[医药卫生—泌尿科学] TP242[医药卫生—外科学]