【摘要】 目的探讨小肾癌患者术前多层螺旋计算机体层摄影血管成像(MSCTA)检查联合术中超声检查在后腹腔镜阻断肾段动脉保留肾单位手术中的应用价值。方法回顾性分析25例接受后腹腔镜选择性肾段动脉阻断保留肾单位手术的小肾癌患者的临床资料。根据是否行术前MSCTA检查联合术中超声检查,分为观察组(接受术前MSCTA检查联合术中超声检查)13例和对照组(未接受术前MSCTA检查联合术中超声检查)12例。比较两组患者围手术期手术相关指标(手术时间、术中出血量、术中热缺血时间、有无微小癌灶、切缘阳性率、术后住院时间及术后漏尿发生情况)水平及手术前后(术前、术后1年)肾功能、术肾肾小球滤过率(GFR)。结果观察组患者术前MSCTA显示肾血管变异情况与术中所见一致;术中超声检查发现微小癌灶1例。观察组患者的手术时间、术中热缺血时间、术后住院时间均短于对照组,差异均有统计学意义(P﹤0.05);观察组患者术中出血量少于对照组,差异有统计学意义(P﹤0.05)。术后病理检查结果显示,观察组与对照组的切缘阳性患者分别为0例和1例。观察组患者术后2周发生漏尿0例,对照组患者术后2周发生漏尿1例。术后1年,观察组患者的尿素氮、肌酐水平均高于对照组,差异均有统计学意义(P﹤0.05)。术前,观察组患者与对照组患者术肾的GFR分别为(55.1±7.2)ml/min和(56.8±7.0)ml/min,两组比较,差异无统计学意义(P﹥0.05);术后1年,观察组患者的GFR为(54.1±7.7)ml/min,高于对照组的(40.4±6.5)ml/min,差异有统计学意义(P﹤0.05)。结论小肾癌患者接受术前MSCTA检查联合术中超声检查,可使术者快速、准确地了解肾段血管,有效切除肿瘤并保留正常肾组织,缩短手术时间、术中热缺血时间、术后住院时间,有利于残留肾功能的恢复。更多还原

【Abstract】 Objective To investigate the value of preoperative multi-slice spiral computerized tomography angiography(MSCTA) combined with intraoperative ultrasound examination in retroperitoneal laparoscopic nephron sparing surgery with segmental renal artery clamping for small renal cell carcinoma patients. Method The medical profiles of 25 patients with small renal cell carcinoma who received retroperitoneal laparoscopic nephron sparing surgery were included in the retrospective analysis. Patients with or without preoperative MSCTA combined with intraoperative ultrasound examination were stratified as study group(with preoperative MSCTA combined with intraoperative ultrasound examination, n=13) and control group(without preoperative MSCTA combined with intraoperative ultrasound examination, n=12). The perioperative measures(operative time, intraoperative blood loss, intraoperative warm ischemia time, presence of microcancer, rate of positive surgical margin, postoperative hospital stay, and postoperative urinary leakage), as well as the renal function, and glomerular filtration rate(GFR) before and 1-year after surgery were recorded and compared between the two groups. Result Preoperative MSCTA indicated consistent renal blood vessel variability with intraoperative findings in study group. Intraoperative ultrasound revealed one case of microcancer. The mean operative time, intraoperative warm ischemia time and postoperative hospital stay of study group were shorter than those in control group,and the differences were statistically significant(P<0.05); lower intraoperative blood loss was observed in study group compared with control group(P<0.05). Postoperative pathology showed that there was 0 and 1 case of positive surgical margin in study group and control group, respectively, in addition, there was no patient in study group who developed urinary leakage but 1 case was observed in control group. In 1 year after surgery, the level of urea nitrogen and creatinine in study group increased significantly compared with control group(P<0.05). The preoperative GFR in study group and control group were(55.1 ± 7.2) ml/min and(56.8 ± 7.0) ml/min(P>0.05), respectively, and was(54.1 ± 7.7) ml/min in study group, which was statistically higher than that in control group at(40.4±6.5) ml/min in 1 year after surgery(P<0.05). Con Conclusion Preoperative MSCTA combined with intraoperative ultrasound can offer rapid and accurate control of renal segmental vessels, through effective resection of tumors and retaining normal renal tissues, it can reduce operative time, intraoperative warm ischemia time and postoperative hospital stay, which helps promote the recovery of residual renal function.更多还原