腔镜超声辅助腹腔镜肾部分切除术治疗中央型肾肿瘤

Intraoperative ultrasonography with laparoscopic nephronsparing surgery for central renal tumors

目的探讨在腹腔镜超声（LUS）辅助下行腹腔镜肾部分切除术治疗中央型肾肿瘤的临床价值。方法回顾性分析LUS辅助行腹腔镜肾部分切除术的23例中央型肾肿瘤患者的临床资料。术中使用LUS明确肿瘤的大小、位置以及肿瘤在肾表面的投影，明确肿瘤与集合系统和肾门肾血管的距离，并评估患者手术时间、术中出血量、术后病理及切缘情况等指标。结果23例中央型肾肿瘤大小为10～48min，平均28mm；肿瘤距集合系统的最短距离≤5mm者8例，距肾门肾血管的最短距离≤5mm者6例。手术时间平均118．2min，其中LOS使用时间平均8．5min，肾蒂阻断时间平均25．2min，术中出血量平均120mL，手术切缘均阴性。结论在中央型肾肿瘤腹腔镜切除术中，使用LUS有助于确定肿瘤位置，可以减少肾单位损失和集合系统、肾血管的损伤．对术后肾功能的保留和恢复具有重要的临床价值。

[ Objective ] To evaluate the value of intraoperative laparoscopic ultrasonography （LUS） in laparoscopic nephron-sparing surgery. [Methods] The laparoscopic doppler probe which was used in the laparoscopic nephron-sparing surgery in 23 patients with central renal tumors was retrospective analyzed. Anatomic findings, the distance between the collection system or renal hilum blood vessels and the tumor, Doppler survey time, dissection time, operative time, estimated blood loss, postoperative pathological finding, and surgical margin status were prospectively recorded. [ Results ] All procedures were successful without conversion to open surgery. The mean size of tumors was 2.8 cm （10-48 ram） and all margins were negative. In eight patients, the distance between the collection system and the tumor was less than 5 ram. In six patients, the distance between the renal hilum blood vessels and the tumor was less than 5 mm. The mean operating time was 118.2 min; mean doppler survey time was 8.5 minutes. Mean hilar vessel dissection time was 25.2 minutes. Mean blood loss was 120 mL. [ Conclusion] LUS provides significant benefit in laparoscopic nephron-sparing surgery. In a number of situations, especially endogenic lesions, it is an essential surgical tool for determining the tumor position,reducing the loss of renal units, prevention of renal vascular damage and preservation of renal function after surgery.