机器人辅助肾部分切除术后创面的超声评价体系构建及临床应用分析

The ultrasound evaluation system and its clinical application forthe renal wound after robotic-assisted nephron-sparing surgery

目的探讨常规超声联合超声造影(CEUS)评估机器人辅助肾部分切除术(RANSS)术后肾脏创面的应用价值,探讨其与术后并发症的相关性。方法选取80例行机器人辅助肾部分切除术的患者。术后第1天使用常规超声检查观察肾脏创面的形态学特征,并对超声图像进行严重程度分级(GUIs)。术后第1天起行超声造影检查,观察肾创面是否存在超声造影剂外渗。比较各组严重程度分级中患者术后并发症发生有无差异,比较超声造影剂外渗及无外渗患者术后并发症发生有无差异,比较各组严重程度分级患者中造影剂外渗构成比及术后并发症有无差异。结果依据常规超声图像,将术后肾脏创面形态按严重程度由低至高分为1级、2级、3级,各等级之间术后并发症构成比差异有统计学意义(P<0.05),等级增加术后并发症比例增加;造影剂外渗组较无外渗组并发症比例增加(P<0.05);GUIs中存在造影剂外渗患者比例随分级增加升高(P<0.05)。结论常规超声联合CEUS可以从形态学上评价RANSS术后肾脏创面,评价结果与术后并发症具有一定相关性。

Objective To evaluate the application of routine ultrasound combined with contrast-enhanced ultrasound(CEUS)for the renal wound after robotic-assisted nephron-sparing surgery(RANSS)and analyze the correlation with the postoperative complications.Methods 80 patients underwent RANSS were involved.Routine ultrasound was performed to evaluate the morphological features the first day after the surgery.A classification system named the grades of ultrasound images(GUIs)was build to evaluate the severity of the renal wound.CEUS was performed on postoperative day 1 to confirm the contrast agent extravasation from the renal wound.The incidence of postoperative complications in different grades was compared,meanwhile compared in the two groups of extravasation or not.Results In GUIs,the routine ultrasound images were classified to three grades:Grade1,Grade2,Grade3.The incidence of postoperative complications increased with GUIs(P<0.05),meanwhile higher in the extravasation group(P<0.05).This trend matched up with GUIs especially in Grade 2 and 3.The incidence of the cases with extravasation increased with GUIs(P<0.05).Conclusion Routine ultrasound and CEUS are feasible to evaluate the morphologic changes of renal wound after RANSS.There is a certain correlation between the evaluation results and the postoperative complications.