术前MSCTA联合术中超声辅助腹腔镜保肾手术治疗小肾癌

Pre-operation MSCTA combined with intraoperative ultrasound for application of laparoscopic kidney-preserving surgery for treatment of small renal cancer

目的观察术前多层螺旋CT血管成像(MSCTA)联合术中超声用于辅助腹腔镜保肾手术治疗小肾癌(肿瘤直径≤4 cm)的效果。方法对85例小肾癌患者行后腹腔镜保留肾单位手术。对其中43例以术前MSCTA联合术中辅助超声(观察组),42例以术前常规肾脏超声及CT检查(对照组)辅助,比较2组相关指标。结果观察组术前MSCTA所示肾肿瘤及肾血管情况与术中所见一致,手术时间、术中热缺血时间、术出血量及术后住院时间均低于对照组(P均<0.05)。观察组术中超声发现微小癌灶1例,术后未见切缘阳性及漏尿。对照组术后2例出现漏尿,置入D-J管保守治疗后痊愈;2例切缘阳性,随访中肿瘤均复发,1例接受后腹腔镜肾肿瘤根治术,1例接受保留肾单位的开放手术。2组间术前、术后血肌酐、尿素氮及患肾肾小球滤过率(GFR)差异均无统计学意义(P均>0.05),对照组术后GFR低于术前(P=0.040)。结论对小肾癌患者行后腹腔镜保留肾单位手术时,术前MSCTA联合术中辅助超声能够减少术中出血量,降低切缘阳性率,尽可能多地保留肾单位,促进患肾功能恢复。

Objective To observe the value of preoperative multi-slice spiral CT angiography(MSCTA)and intraoperative assisted ultrasound in application of laparoscopic kidney-preserving surgery for treating small renal cancer(tumor diameter≤4 cm).Methods A total of 85 patients with small kidney cancer underwent retroperitoneal laparoscopic nephron-sparing surgery,including 43 underwent preoperative MSCTA and intraoperative assisted ultrasound(observe group)and 42 underwent preoperative routine renal ultrasound and CT examination(control group).The relevant indicators were compared between the two groups.Results Preoperative MSCTA findings of observe group were consistent with intraoperative findings.The operative time,intraoperative heat ischemia time,intraoperative blood loss and postoperative hospital stay in observe group were all less than those in control group(all P<0.05).In observe group,microcarcinoma was found in 1 case with ultrasound during operation,no positive resection margin nor urine leakage occurred after operation.In control group,postoperative urine leakage occurred in 2 patients(cured after conservative treatment with D-J tube implantation)and positive resection margin in 2 patients(recurred in the follow-up,1 underwent retroperitoneal laparoscopic radical nephrectomy,and 1 underwent nephron sparing open surgery).There was no statistical difference of preoperative nor postoperative levels of serum creatinine,urea nitrogen and glomerular filtration rate(GFR)of affected kidney between the two groups(all P>0.05),while the postoperative GFR of control group was lower than that before surgery(P=0.040). Conclusion Preoperative MSCTA and intraoperative auxiliary ultrasound during retroperitoneal laparoscopic nephron-sparing surgery for patients with small renal carcinoma can reduce intraoperative blood loss and positive rate of resection margin,reserve as much nephrons as possible to promote the recovery of renal function.