术中超声辅助下行孤立肾肾癌保留肾单位手术效果观察

目的：探讨术中超声辅助下孤立肾肾癌保留肾单位手术对选择性肾动脉阻断以及确定肿瘤切缘的作用。方法：回顾2004-2011年先天性或获得性孤立肾肾细胞癌行保留肾单位手术患者资料，共7例术中采用超声多普勒确认肾段动脉阻断效果，并对肿瘤包膜边缘行超声检测从而进一步确定肿瘤切缘。术后1个月、6个月以及1年随访对比术前肾功能变化，并规律随访患者预后至今。结果：7例手术均成功行保留肾单位手术，超声引导检测下行选择性肾段动脉阻断5例，另2例采用单纯肾动脉于阻断下手术，术中超声发现肿瘤可疑卫星灶2例并指导切缘。术后6个月及1年随访肾功能与术前相比无明显下降，所有患者随访至今，平均随访45．4个月，均未见肿瘤复发或转移。结论：术中超声辅助下行保留肾单位手术是治疗孤立肾肾癌的理想方法，有助于肿瘤的准确切除和肾功能保护。

Intraoperative ultrasonic monitoring to assist nephron sparing surgery for solitary kidney renal carcinoma

Objective：To evaluate the value of intraoperative ultrasonic monitoring （IOUS） to assist judging the effect of selective blockage of renal artery and margins of tumors in nephron sparing surgery （NSS） for renal carcinoma of solitary kidney. Method：From 2004 to 2011, nephron sparing surgery was used to treat 7 cases of congenial or acquired solitary kidneys renal carcinoma. IOUS has been used for judging the effect of selective blockage of renal artery and margins of tumors during the process of the surgry. 1 month and 6 month after sur- gery, postoperative follow-up has been done which mainly included renal function and tumor recurrence or metas- tasis, and the mean follow-up time is 45.4 m. Result： Operations were successful in all the cases. Ultrasonic doppler has been used for judging the effect of selective blockage of renal artery in 5 cases underwent NSS. In 2 ea- ses, tumor satellite focal has been exposed under ultrasonic test during surgry. The patients were followed up with well recovered renal function 6m after surgery and without any tumor recurrence or metastasis. Conclusion：The ex- periences of intraoperative ultrasonic monitoring （IOUS） are encouraging in nephron sparing surgery. It is an ideal method for a precise tumor resection and renal function protection in patients with solitary kidneys renal carcino-ma.