术中超声辅助下后腹腔镜肾部分切除术治疗完全性肾内型肿瘤的疗效  

Efficacy of intraoperative ultrasound assisted localization in retroperitoneal laparoscopic partial nephrectomy for completely endogenous renal tumor

作　　者：王敏[1] 刘修恒[1] 陈志远[1] 陈晖[1] 翁小东[1] WANG Min;LIU Xiuheng;CHEN Zhiyuan;CHEN Hui;WENG Xiaodong(Dept.of Urology,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China)

机构地区：[1]武汉大学人民医院泌尿外科,湖北武汉430060

出　　处：《武汉大学学报（医学版）》2023年第7期819-823,共5页Medical Journal of Wuhan University

基　　金：湖北省自然科学基金(编号:2019CFB302)。

摘　　要：目的:探讨术中超声辅助下后腹腔镜肾部分切除术治疗完全性肾内型肿瘤的有效性及安全性。方法:对2017年9月至2019年9月在武汉大学人民医院泌尿外科收治的29例完全性肾内型肿瘤并接受后腹腔镜肾部分切除术患者的临床资料进行回顾性分析,其中接受超声辅助下后腹腔镜肾部分切除术患者11例(超声辅助组),接受非超声辅助下、单纯后腹腔镜肾部分切除术患者18例(对照组),分析患者的手术成功率,比较两组中成功完成后腹腔镜肾部分切除术患者的热缺血时间、术中出血量、切缘阳性率、切缘厚度、手术后住院时间以及术后并发症和肾小球滤过率(GFR)等参数指标。结果:11例超声辅助组患者,手术均顺利完成(成功率100%),无中转开放手术;18例对照组患者中,12例手术顺利完成(成功率66.7%),2例中转开放行肾部分切除术,另外4例患者改行根治性肾切除;超声辅助组与对照组比较,平均热缺血时间较短(20.6 min vs 30.8 min,P<0.05)、平均术中出血量较少(142.3 mL vs 320.8 mL,P<0.05),输血发生率(1/11 vs 4/12,P>0.05)、切缘阳性率(1/11 vs 2/12,P>0.05)无显著差异,平均切缘厚度(4.7 mm vs 9.0 mm,P<0.05)、平均手术后住院时间(6.9 d vs 9.5 d,P<0.05)有显著差异,术后并发症发生率无显著差异(1/11 vs 4/12,P>0.05)、平均术后患肾GFR较高(45.2 mL/min vs 40.1 mL/min,P<0.05)。结论:术中超声辅助下后腹腔镜肾部分切除术治疗完全性肾内型肿瘤是一种安全、有效且创伤小的治疗选择。Objective:To explore the efficacy and safety of intraoperative ultrasound assisted localization in retroperitoneal laparoscopic partial nephrectomy for treatment of completed endogenous renal tumor.Methods:The clinical data of 29 patients diagnosed as completed endogenous renal tumor who were underwent retroperitoneal laparoscopic partial nephrectomy from 2017 September to 2019 September in Renmin Hospital of Wuhan University were analyzed retrospectively.Eleven patients were per⁃formed operation with intraoperative ultrasound were divided into intraoperative ultrasound group,and the other 18 patients without intraoperative ultrasound were divided into control group.The rate of success of operation was analyzed.The data of warm ischemia time,blood loss,surgical margins,postoperative length of hospitalization,postoperative complications and glomerular filtration rate(GFR)were evaluated.Results:All cases in the intraoperative ultrasound group were successfully per⁃formed with retroperitoneal laparoscopic partial nephrectomy,and none needed open surgery.Howev⁃er,12 cases in the control group were successfully performed with retroperitoneal laparoscopic partial nephrectomy,2 cases were converted to open partial nephrectomy,and 4 cases were converted to rad⁃ical nephrectomy.Compared with that respectively in control group,average warm ischemia time was shorter(20.6 min vs 30.8 min),average blood loss was less(142.3 mL vs 320.8 mL,P<0.05),blood transfusion rate(1/11 vs 4/12,P>0.05)and rate of positive surgical margin(1/11 vs 2/12,P>0.05)showed no difference,average thickness of surgical margin(4.7 mm vs 9.0 mm,P<0.05)and average postoperative length of hospitalization(6.9 d vs 9.5 d,P<0.05)was less,rate of postop⁃erative complications(1/11 vs 4/12,P>0.05)showed no difference,and average postoperative renal GFR was more(45.2 mL/min vs 40.1 mL/min,P<0.05)in ultrasound group.Conclusion:Intra⁃operative ultrasound assisted localization in retroperitoneal laparoscopic partial nephrectomy was safe,effective,and mi

关 键 词：术中超声 后腹腔镜肾部分切除术 完全性肾内型肿瘤 回顾性分析 

分 类 号：R737.11[医药卫生—肿瘤]