摘要
内生型肾肿瘤无肾脏表面突出,位置深,术中辨认较困难。且肿瘤与肾脏血管或肾脏集合系统距离更近,手术难度较大。对内生性肾肿瘤患者,术前需完善腹部增强CT和血管重建,通过仔细阅读泌尿系CT或MRI片,粗略估计肾肿瘤在肾脏表面的投影位置,再在腹腔镜引导下将超声探头置于投影位置表面以明确肿瘤准确位置。静脉注射吲哚菁绿结合近红外显像技术也有助于术中定位。采用腹腔镜保留肾单位手术(LNSS)切除完全内生型肾肿瘤。以"两头线在肾被膜外"的方法缝合残余肾脏创面,可使连续缝合后对合良好。完全内生型肾肿瘤行保留肾单位手术后切缘阳性率为0.0%~9.1%。在预后方面,内生型肾肿瘤与外周型相似。虽然腹腔镜肾部分切除术治疗完全内生型肾肿瘤存在技术难度,但确是安全有效的。充分的术前评估,准确的术中定位及术者丰富的腹腔镜手术经验是此类手术成功的关键。
Management for completely endophytic renal tumors represents a technical challenge during laparoscopic nephron sparing surgery(LNSS)since,unlike exophytic tumors,there are no external visual cues on the renal surface to guide tumor localization or excision.Moreover,the tumors are close to the renal vascular or collection system.For patients with completely endophytic renal tumors,it is important to take enhanced abdominal CT and vascular reconstruction.By reading the urinary CT or MRI carefully,we get a rough estimate renal tumor position under the surface of the kidney.Then the laparoscopic guided ultrasonic probe can determine the exact location of the tumor.Intravenous injection of indocyanine green combined with near infrared imaging technique is also helpful for intraoperative localization.In LNSS,we can suture the residual kidney tissue with'both ends of the sutures outside the renal capsule'and obtain satisfactory results.The positive margin of LNSS is 0 to 9.1%.In terms of tumor prognosis,the complete endophytic renal tumors are similar to exophytic tumors.Although laparoscopic partial nephrectomy is technically difficult,it is safe and effective.Sufficient preoperative evaluation,accurate intraoperative localization,and extensive laparoscopic surgery experience are the keys to the success of the procedure.
出处
《现代泌尿外科杂志》
CAS
2017年第11期815-817,856,共4页
Journal of Modern Urology
关键词
内生肾肿瘤
腹腔镜
定位
切缘
预后
endophytic renal tumors
laparoscope
localization
margin
prognosis
