术中超声在机器人辅助腹腔镜下完全内生性肾肿瘤剜除术中的作用及技术分享

Role and technique of intraoperative ultrasound during robot-assisted renal tumor enucleation for endophytic renal tumors

目的:评价术中超声在机器人辅助腹腔镜下完全内生性肾肿瘤剜除术中的作用并介绍术中超声探头的使用方法。方法:将2014年10月~2016年3月我院32例完全内生性肾肿瘤且PADUA评分≥10分并行机器人辅助腹腔镜下肾肿瘤剜除术的患者(年龄35~74岁,中位年龄55岁)纳入此次回顾性研究。其中19例患者术中使用了超声(术中超声组),13例患者术中未使用超声(非术中超声组)。分别对两组手术结果、病理结果数据进行收集和统计学分析。结果:术中超声组的术中出血量和热缺血时间显著低于非术中超声组(P<0.05),而两组手术时间和住院天数比较差异无统计学意义(P>0.05)。围手术期术中超声组共出现3例并发症,非术中超声组出现4例并发症,差异无统计学意义(P>0.05)。术后的病理结果显示两组各有2例良性病变,恶性肿瘤切缘均为阴性,术中超声组的癌组织距切缘最近距离要显著短于非术中超声组(P<0.05)。结论:术中超声辨别完全内生性肾肿瘤的边界,有利于手术的安全进行,同时可在保证切缘阴性的前提下最大程度地保留肾单位,可在机器人辅助腹腔镜下完全内生性肾肿瘤的剜除术中更多的运用。

Objective： To introduce the role and method of intraoperative ultrasound （IOUS） performed in ro- bot-assisted renal tumor enucleation （RARTE） for endophytic renal tumors. Method： From October 2014 to March 2016, 32 completely endophytic renal tumor patients （age range 35 to 74, median age 55 years old） who could be attributed at least 10 points according to the PADUA score were retrospectively analyzed. Nineteen pa- tients who had undergone RARTE with IOUS for endophytic renal tumors were grouped. RARTE was carried out in another 13 patients without IOUS and these 13 patients were also grouped. The demographical data, surgical outcomes and pathologic results were retrospectively reviewed. Result： There were significantly less estimated blood loss and shorter warm ischemia time in IOUS group compared to non-IOUS group （P〈0.05）. However, there was no significant difference in operation time and hospital stay （P〉0.05）. Moreover, complications oc- curred in 3 cases in IOUS group and in 4 cases in non-IOUS group. The Clavien-Dindo Classification did not differ significantly between the two groups （P〉0.05）. Although, pathologic results showed that each group had 2 be- nign cases and no positive margins existed. The shortest distance between cancer and surgical margin in IOUS group was significantly shorter compared to non-IOUS group （P〈0.05）. Conclusion： Overall, we believe that IOUS may provide patients a more effective and safer procedure. A robotic ultrasound probe operated by the skilled surgeon could help with nephron sparing at utmost during RARTE without increasing the risk of positive surgical margin. Thus, IOUS was worth to be utilized when operating RARTE for completely endophytic renal tumors.