混合现实技术联合实时超声在腹腔镜下肾部分切除术治疗完全内生型肾肿瘤的临床应用

Laparoscopic partial nephrectomy in the treatment of complete endogenous renal tumor by mixed reality technology and real-time ultrasound monitoring

目的探讨混合现实技术联合实时超声在腹腔镜下肾部分切除术治疗完全内生型肾肿瘤的临床效果。方法回顾性分析2020年1月-2021年12月在阜阳市人民医院行腹腔镜下肾部分切除术治疗的3例完全内生型肾肿瘤患者的临床资料。肿瘤位于左侧1例,右侧2例。患者术前均行双肾增强CT,采集图像数据构建三维可视化模型,术中借助混合现实(MR)技术与腔镜影像融合辅助导航,并结合实时超声对比,从而对瘤体进行精准定位、分离和剜除。术后定期进行随访。结果3例患者均顺利完成腹腔镜手术,无中转开放。平均手术时间205(160~270)min;平均阻断肾动脉时间26(18~30)min;术中平均出血110(80~150)mL,均未输血;平均术后住院时间7.3(6~9)d。术后病理诊断:乳头状肾细胞癌2例、嗜酸细胞腺瘤1例,手术切缘均为阴性。3例均获随访,术后随访平均7.7(1~13)个月。术后1个月复查血肌酐平均99.4(54.7~185.7)μmol/L。术后1例患者血肌酐升高,其余2例患者肾功能无异常。所有患者影像学检查未见肿瘤复发征象。结论混合现实技术联合实时超声行腹腔镜下肾部分切除术治疗完全内生型肾肿瘤安全有效,可以完整切除瘤体,最大限度地保留肾单位。

Objective To explore the clinical efficacy of laparoscopic partial nephrectomy(LPN)in the treatment of complete endogenous renal tumor by mixed reality technology and real-time ultrasound monitoring.Methods The clinical data of 3 cases of complete endogenous renal tumor receiving LPN during Jan.2020 and Dec.2021 were retrospectively analyzed.The tumor was located on the left in 1 case and on the right side in 2 cases.All patients underwent double kidney enhanced CT before surgery,and the imaging data were collected to build a 3D visual model.During operation,mixed reality technology was integrated with endoscopic images to assist navigation.Real-time ultrasound contrast was used for accurate positioning,isolation and enucleation of the tumor.Results All operations were successful without conversion to open surgery.The mean operation time was 205(160~270)min;average renal artery blocking time was 26(18~30)min;intraoperative bleeding was 80~150 mL,mean 110 mL;no case needed blood transfusion;mean postoperative hospital stay was 7.3(6~9)d.Postoperative pathology confirmed papillary renal cell carcinoma in 2 cases and acidophilic adenoma in 1 case,and the surgical margin was negative.All patients were followed up for 7.7(1~13)months.The average blood creatinine was 99.4(54.7~185.7)μmol/L 1 month after surgery.One patient had elevated creatinine.No tumor recurrence was observed.Conclusion Mixed reality technology combined with real-time ultrasound laparoscopic partial nephrectomy is safe and effective in the treatment of completely endogenous renal tumor,which can completely remove the tumor and maximumly spare the nephrons.