腹腔镜术中超声在中央型肾肿瘤行腹腔镜肾部分切除术的临床应用

目的:探讨腹腔镜超声(LUS)在中央型肾肿瘤行腹腔镜肾部分切除术(LPN)的临床价值。方法:回顾分析在LUS协助下行LPN的10例中央型肾肿瘤患者的临床资料。所有患者术前B超、CT和/或MR等影像学检查诊断为肾肿瘤,肿瘤均位于肾实质内,无明显外凸。男6例,女4例,年龄10~62岁(平均45.4岁),5例位于肾中部,1例位于肾上极,4例位于肾下极,肿瘤直径1.1~3.5cm,平均直径2.6cm。结果:腹腔镜术中超声对肿瘤位置、大小、边界和血供进行实时定位,确定肾肿瘤切除的范围,切除后再次复查超声,保证切缘阴性。术后病理回报:肾细胞癌9例,肾素瘤1例,所有切缘均阴性。结论:术中LUS可提供实时影像,协助手术医师准确定位包埋于肾皮质的中央型肾肿瘤,对肿瘤进行实时评估,减少术中出血,保障切缘阴性,为手术安全提供有效保障。

Clinical application of laparoscopic ultrasonography in laparoscopic partial nephrectomy for centrally located renal tumors

Objective： To investigate the clinical application of laparoscopic ultrasonography （LUS） in laparo- scopic partial nephrectomy （LPN） for centrally located renal tumors. Method： The clinical data of ten patients who underwent LPN for centrally located renal tumors with LUS were retrospectively analyzed. All patients were diagnosed of renal tumors by B ultrasound, CT and/or MR examinations. The tumors were located in the renal pa- renchyma without obvious evagination, with five cases in the middle, one case in the upper pole and four cases in the lower pole of the kidney. There were six males and four females, aged from 10-62 （mean, 45.4） years old. The tumor size was 1.1-3. 5 （mean 2.6） cm, Result： LUS could confirm the location, size, blood supply and boundary of renal tumors, and determine that the tumor was removed completely with negative incisal margin. The pathological results showed that renal cell carcinoma was found in nine cases and reninoma was seen in one pa- tient. The surgical incisal margins were negative in all ten cases. Conclusion： It is of high clinical value for LUS in LPN for centrally located renal tumors with real-time image and it helps surgeons to determine the location of the tumor, reduce intraoperative hemorrhage, provide negative incisal margins and guarantee the operation safety.