术前多层螺旋CT血管成像、术中超声在后腹腔镜阻断肾段动脉肾部分切除术中的应用
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摘要
目的探讨术前多层螺旋CT血管成像(multi-slice spiral CT angiography,MSCTA)及术中超声在小肾癌阻断肾段动脉后腹腔镜肾部分切除术中的应用价值。方法小肾癌病人55例,常规术前行MSCTA检查,根据是否行术中超声,将其分为术中超声组28例,非术中超声组27例。比较两组手术时间、出血量、术中热缺血时间、微小癌灶发现率、中转开放率、术后漏尿、切缘阳性率、术肾肾小球滤过率(glomerular filtration rate,GFR)。结果术中超声组各项观测指标均优于非术中超声组,其手术时间分别为(172. 1±3. 5)分钟和(216. 3±4. 8)分钟,术中出血量分别为(70. 2±5. 0) ml和(90. 3±4. 0) ml,术中热缺血时间分别为(24. 5±4. 2)分钟和(29. 3±2. 8)分钟,差异有统计学意义(P <0. 05)。术中超声组术前、术后患肾GFR分别为(55. 1±7. 2) ml/min和(54. 1±7. 7) ml/min(P> 0. 05),非术中超声组术前、术后患肾GFR分别为(55. 8±7. 0) ml/min和(41. 4±6. 5) ml/min(P <0. 05)。结论术中超声可以快速准确的定位肿瘤组织,尽可能的保留肾单位,减少切缘阳性率,并有利于术后患肾功能的恢复。
Objective To investigate the value of preoperative multi-slice spiral CT angiography( MSCTA) and intraoperative ultrasound in laparoscopic occlusion of renal segmental arterial partial nephrectomy. Methods Forty-eight patients with small renal cell carcinoma underwent routine MSCTA examination. According to whether intraoperative ultrasound was performed,28 patients were divided into intraoperative ultrasound group and 27 patients without intraoperative ultrasound. The operation time,blood loss,intraoperative warm ischemia time,microscopic cancer discovery rate,transit opening rate,postoperative leakage of urine,positive margin of cutting edge and glomerular filtration rate( GFR) were measured.Results The intraoperative ultrasound group was better than the non-operative ultrasound group. The operation time was( 172. 1 ± 3. 5) min and( 216. 3 ± 4. 8) min,respectively; the intraoperative blood loss was( 70. 2 ± 5. 0) ml and( 90. 3 ± 4. 0) ml,respectively; the ischemic time was( 24. 5 ± 4. 2) min and( 29. 3 ±2. 8) min,respectively,and the difference were all statistically significant( P < 0. 05). The preoperative and postoperative renal GFR of the intraoperative ultrasound group were( 55. 1 ± 7. 2) ml/min and( 54. 1 ± 7. 7) ml/min( P > 0. 05),respectively. The non-operative ultrasound group had a renal GFR of( 55. 8 ± 7. 0) ml/min and( 41. 4 ± 6. 5) ml/min before and after surgery( P < 0. 05). Conclusion Intraoperative ultrasound can quickly and accurately locate the tumor tissue,preserve the nephron as much as possible,reduce the positive rate of the margin,and facilitate the recovery of renal function after surgery.
Objective To investigate the value of preoperative multi-slice spiral CT angiography( MSCTA) and intraoperative ultrasound in laparoscopic occlusion of renal segmental arterial partial nephrectomy. Methods Forty-eight patients with small renal cell carcinoma underwent routine MSCTA examination. According to whether intraoperative ultrasound was performed,28 patients were divided into intraoperative ultrasound group and 27 patients without intraoperative ultrasound. The operation time,blood loss,intraoperative warm ischemia time,microscopic cancer discovery rate,transit opening rate,postoperative leakage of urine,positive margin of cutting edge and glomerular filtration rate( GFR) were measured.Results The intraoperative ultrasound group was better than the non-operative ultrasound group. The operation time was( 172. 1 ± 3. 5) min and( 216. 3 ± 4. 8) min,respectively; the intraoperative blood loss was( 70. 2 ± 5. 0) ml and( 90. 3 ± 4. 0) ml,respectively; the ischemic time was( 24. 5 ± 4. 2) min and( 29. 3 ±2. 8) min,respectively,and the difference were all statistically significant( P < 0. 05). The preoperative and postoperative renal GFR of the intraoperative ultrasound group were( 55. 1 ± 7. 2) ml/min and( 54. 1 ± 7. 7) ml/min( P > 0. 05),respectively. The non-operative ultrasound group had a renal GFR of( 55. 8 ± 7. 0) ml/min and( 41. 4 ± 6. 5) ml/min before and after surgery( P < 0. 05). Conclusion Intraoperative ultrasound can quickly and accurately locate the tumor tissue,preserve the nephron as much as possible,reduce the positive rate of the margin,and facilitate the recovery of renal function after surgery.
引文
[1]杨翌.探讨后腹腔镜肾部分切除术治疗肾肿瘤的临床应用价值[J].中外医学研究,2015,13(20):58-59.
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[4]刘清学,高飞,彭洪,等.双向倒刺缝合线在不阻断肾动脉的后腹腔镜肾部分切除术中的应用[J].四川医学,2015,36(10):1407-1409.
[5]王斌,宋继文,陈惠庆,等.倒刺可吸收线在后腹腔镜肾部分切除术中的应用[J].肿瘤研究与临床,2016,28(9):616-619.
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[7]李鹏,杨庆,肖成武,等.超选择性肾动脉分支阻断技术在经腹腹腔镜肾部分切除术中的初步应用[J].第二军医大学学报,2015,36(2):183-187.
[8]胡啸天,彭澎,段支前.经脐单孔腹腔镜下小儿重复肾半肾切除术的临床分析[J].发育医学电子杂志,2016,4(2):99-102.
[9]朱新胜,周佗,王令令,等.单孔经腹腹腔镜肾切除术的治疗管理分析(附5例报告)[J].中国卫生产业,2016,13(6):20-22.
[10]陈威,肖龙明,杨巧智,等.肾段动脉阻断与肾动脉全阻断在后腹腔镜肾部分切除术中的应用比较[J].基层医学论坛,2018,22(7):935-936.
[11]孙爱军.后腹腔镜下根治性肾切除术的疗效及安全性分析[J].中国药物经济学,2017,12(1):97-99.
[12]宋殿宾,于满,迟强,等.多层螺旋CT血管成像在小肾癌NSS中的应用价值[J].实用医学杂志,2013,29(11):1825-1827.
[13]魏勇,蔡海,许宁,等.CTA技术在腹腔镜选择性肾段动脉阻断肾部分切除术中的应用[J].临床放射学杂志,2014,33(12):1891-1894.
[14]Maurice M J,Zhu H,Kim S P,et al.Reexamining the association between positive surgical margins and survival after partial nephrectomy in a large American cohort[J].J Endourol,2016,30(6):698-703.
[15]邱敏,向军吉,马潞林,等.实时超声监测后腹腔镜下肾部分切除术治疗完全内生型肾肿瘤的疗效分析[J].中华泌尿外科杂志,2016,37(10):730-734.
[2]杨琦,王养民,常德辉,等.腹腔镜与开放肾部分切除术疗效及围手术期并发症的对比研究[J].临床外科杂志,2018,26(2):127-130.
[3]唐亮,方卫华,廖贵益,等.无结式连续缝合术在后腹腔镜下肾部分切除术中的应用[J].安徽医科大学学报,2013,48(12):1547-1549.
[4]刘清学,高飞,彭洪,等.双向倒刺缝合线在不阻断肾动脉的后腹腔镜肾部分切除术中的应用[J].四川医学,2015,36(10):1407-1409.
[5]王斌,宋继文,陈惠庆,等.倒刺可吸收线在后腹腔镜肾部分切除术中的应用[J].肿瘤研究与临床,2016,28(9):616-619.
[6]刘翔,唐朝朋,周文泉.腹腔镜下肾部分切除术减少热缺血时间的研究进展[J].临床外科杂志,2016,24(12):966-968.
[7]李鹏,杨庆,肖成武,等.超选择性肾动脉分支阻断技术在经腹腹腔镜肾部分切除术中的初步应用[J].第二军医大学学报,2015,36(2):183-187.
[8]胡啸天,彭澎,段支前.经脐单孔腹腔镜下小儿重复肾半肾切除术的临床分析[J].发育医学电子杂志,2016,4(2):99-102.
[9]朱新胜,周佗,王令令,等.单孔经腹腹腔镜肾切除术的治疗管理分析(附5例报告)[J].中国卫生产业,2016,13(6):20-22.
[10]陈威,肖龙明,杨巧智,等.肾段动脉阻断与肾动脉全阻断在后腹腔镜肾部分切除术中的应用比较[J].基层医学论坛,2018,22(7):935-936.
[11]孙爱军.后腹腔镜下根治性肾切除术的疗效及安全性分析[J].中国药物经济学,2017,12(1):97-99.
[12]宋殿宾,于满,迟强,等.多层螺旋CT血管成像在小肾癌NSS中的应用价值[J].实用医学杂志,2013,29(11):1825-1827.
[13]魏勇,蔡海,许宁,等.CTA技术在腹腔镜选择性肾段动脉阻断肾部分切除术中的应用[J].临床放射学杂志,2014,33(12):1891-1894.
[14]Maurice M J,Zhu H,Kim S P,et al.Reexamining the association between positive surgical margins and survival after partial nephrectomy in a large American cohort[J].J Endourol,2016,30(6):698-703.
[15]邱敏,向军吉,马潞林,等.实时超声监测后腹腔镜下肾部分切除术治疗完全内生型肾肿瘤的疗效分析[J].中华泌尿外科杂志,2016,37(10):730-734.