腹腔镜超声在机器人辅助腹腔镜肾部分切除术中的应用价值

目的:研究腹腔镜超声(laparoscopic ultrasonography,LUS)在机器人辅助腹腔镜肾部分切除术(robot assisted laparoscopic partial nephrectomy,RALPN)中的应用价值。方法:回顾分析2012年4月至2013年3月为41例患者行RALPN的临床资料,其中LUS引导23例(实验组),无LUS引导18例(对照组),手术均由同一泌尿外科医师施术。两组患者术前分期均为T1N0M0。实验组术前肿瘤直径1.5~5.3 cm,平均(3.19±1.12)cm;对照组1.5~6.1 cm,平均(3.34±1.30)cm。对比分析两组手术时间、热缺血时间、术中出血量、术后第3天血肌酐值、术后并发症等指标。结果:两组患者年龄、术前肿瘤最大径、BMI、术中出血量、术后住院时间、术后切缘阳性率差异无统计学意义(P>0.05)。手术时间[(223.8±42.1)min vs.(203.4±56.6)min]、肾脏热缺血时间[(18.9±7.7)min vs.(31.2±7.1)min]、术后第3天血肌酐值≥110μmol/L(参考值上限)发生率(17.39%vs.50.00%)差异有统计学意义(P<0.05)。结论:LUS实时动态的扫描,可准确提供肿瘤的位置、大小、范围、深度及血供情况,为手术的安全性、减少肿瘤残留与复发、降低术后并发症发生率提供了保障,短期疗效较好,但其长期疗效尚需大样本病例随访观察进一步分析研究。

Application of laparoscopic ultrasonography in robot assisted laparoscopic partial nephrectomy

Objective ：To investigate the clinical benefits and value of laparoscopic ultrasonography （LUS） in the robot assisted laparoscopic partial nephrectomy （RALPN）. Methods：A retrospective analysis was performed for 41 patients who underwent RALPN between Apr. 2012 and Mar. 2013. The 41 patients were divided into two groups：group A was LUS-guided （n = 23 ） and group B was without LUS （ n = 18）. All the surgeries were completed by the same urologist surgeon. Preoperative clinical stages of both groups were T No Mo. The maximum size of tumor in the two groups were （3.19 ± 1.12） cm （ range 1.5-5.3 cm）, （ 3.34 ± 1.30） cm （ range 1.5- 6.1 cm）. The operation time,warm ischemia time, estimated blood loss, postoperative 3 d serum ereatinine,postoperative complications were compared between A and B groups. Results：There were no significant differences between the two groups regarding the ages, the max-size of tumor, BMI, estimated blood loss, postoperative hospital stay, positive surgical margin rate （P 〉 0.05 ）. Patients undergoing the LUS had a significantly longer operation time [ （223. 5± 42.1 ） min vs. （203.4 ±56.6） min, P 〈 0.05 ] and shorter warm ischemi- a time [ （18.9 ± 7.7） min vs. （31.2± 7.1 ） min, P 〈 0.05 ] compared with group B. The incidence of postoperative serum creatinine no less than 110 μmol/L （reference range upper limit） in group B （50.00%） were higher than group A （ 17.39% ） （P 〈0.05）. Conclusions：LUS with real time dynamic scanning could clearly and accurately locate the position of tumors, provide the size, scope, depth and blood supply of tumor, guarantee the safety and efficacy for RALPN, the decline of tumor residual, recurrence and postopera- tive complications. The short-term effect is favorable, but the long-term effect still needs forward study by large-scale cases following-up and prospective double blind study.