MSCTA 联合术中超声在小肾癌后腹腔镜肾部分切除手术中的应用价值

Application value of multi-slice spiral CT angiography combined with intraoperative laparoscopic ultrasound in partial nephrectomy of small renal cancer

摘要:

目的??探讨多层螺旋 CT 血管成像 （MSCTA） 联合术中超声在小肾癌后腹腔镜肾部分切除术 （LPN） 中的应用价值。方法??选择影像学显示肿瘤直径≤ 4.0?cm 的小肾癌患者 55 例， 其均采用后腹腔镜肾部分切除术。根据术中是否行超声，将其分为超声组（28 例）和非超声组（27 例） 。左肾肿瘤 33 例，右肾肿瘤 22 例 ； 肿瘤直径为 1.5 ～ 5.0?cm， 平均 3.0?cm。比较两组手术时间、出血量、术中热缺血时间、微小癌灶发现率、术后漏尿、切缘阳性率及肾小球滤过率（GFR）功能。结果??超声组手术时间少于非超声组（ P ?<0.05） ，超声组术中出血量少于非超声组（ P ?<0.05） ； 超声组术中热缺血时间少于非超声组（ P ?<0.05） ； 中转开放手术例数超声组少于非超声组（ P ?<0.05） 。微小病灶检出例数 ： 超声组 1 例 ； 非超声组 0 例 ； 术后漏尿例数 ： 超声组 0 例，非超声组 1例。切缘阳性率： 超声组为 0.0%， 非超声组为 3.7%。超声组术前、 术后患肾 GFR 分别为（55.1±7.2）和（53.1±7.7） ml/min （ P ?>0.05） ，非超声组术前、术后患肾 GFR 分别为（55.8±7.0）和（50.4±6.5）ml/min （ P ?>0.05） 。结论?术中超声可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， 有利于术后患肾功能的恢复。

Abstract:

Objective To investigate the application value of multi-slice spiral CT angiography (MSCTA) combined with intra-operative ultrasound in the treatment of small renal cancer by laparoscopic partial nephrectomy (LPN). Methods A total of 55 patients with small renal cell carcinoma (SRCC) with tumor diameter ≤ 4.0 cm were selected. All patients underwent retroperitoneal laparoscopic partial nephrectomy. According to whether ultrasound was performed during surgery, it was divided into ultrasound group (28 cases) and non-ultrasound group (27 cases). There were 33 cases of left kidney tumor and 22 cases of right kidney tumor. The diameter of the tumor was 1.5 -5.0 cm, with an average of 3.0 cm. The operation time, blood loss, intraoperative warm ischemia time, microscopic cancer discovery rate, postoperative leakage of urine, positive margin and glomerular filtration rate (GFR) were compared between the two groups. Results The operation time of the ultrasound group was less than that of the non- ultrasound group (P < 0.05). The amount of bleeding in the ultrasound group was less than that in the non-ultrasound group (P < 0.05). The time of warm ischemia in the ultrasound group was less than that in the non-ultrasound group (P < 0.05). The number of open surgery cases was lower in the ultrasound group than in the non-ultrasound group (P < 0.05).The number of cases detected by microscopic lesions: 1 in the ultrasound group and 0 in the non- ultrasound group; the number of postoperative urinary leakage: 0 in the ultrasound group and 1 in the non-ultrasound group. The margin of positive margin was 0.0% in the ultrasound group and 3.7% in the non-ultrasound group. The renal GFR of the ultrasound group was (55.1 ± 7.2) and (53.1 ± 7.7) ml/min (P > 0.05) before and after operation, and the renal GFR of the non-ultrasound group before and after operation was (55.8 ± 7.0) and (50.4 ± 6.5) ml/min (P > 0.05). Conclusions Intraoperative ultrasound can quickly and accurately locate the tumor tissue, preserve the nephron as much as possible, and reduce the positive rate of the margin, which is beneficial to the recovery of renal function after operation.