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目的尝试应用超声内镜指导后腹腔镜下内生性肾脏肿瘤保留肾单位手术,总结临床实践经验,探讨其可行性及临床价值。方法对1例28岁女性右肾占位患者(肿瘤大小1.4 cm×1.0 cm,临床分期为T1aN0M0)行后腹腔镜下保留肾单位手术;术中因肾脏表面光滑,无明显突起,无法准确定位肿瘤,以超声支气管镜探头定位肿瘤,观察肿瘤血供及其与周围肾脏组织的关系;按超声内镜定位标志行保留肾单位手术。观察切除肿瘤的完整性及切缘情况。结果超声内镜下肿瘤范围、血供清晰可辨,阻断肾动脉后未见肿瘤周围有明显血流声像,沿肿瘤边缘约0.5～1.0 cm完整切除肿瘤,术中未中转开放手术。超声内镜操作时间为5 min。术后病理提示血管平滑肌脂肪瘤,切缘阴性。结论在1例后腹腔镜下内生性肾脏肿瘤保留肾单位手术中应用超声内镜成功进行了肿瘤定位、肿瘤血供评判,为彻底切除肿瘤提供了依据,值得进一步研究以利于临床推广。
Objective To evaluate the feasibility and clinical value of laparoscopic nephrotic nephrectomy after laparoscopic nephrectomy. To summarize the experience of clinical practice and to explore its feasibility and clinical value. Methods Nephron surgery was performed in a 28-year-old female with right renal pelvis (tumor size 1.4 cm × 1.0 cm, clinical stage T1aN0M0) after laparoscopy. Because of the smooth surface of the kidney during operation, there was no obvious protrusion and could not be accurately located Tumors were located by ultrasound bronchoscopy probe to observe the tumor blood supply and its relationship with the surrounding kidney tissue; according to the endoscopic ultrasound sonography to retain the line of surgery. Observe the excision of tumor integrity and margins. Results The scope of the endoscopic ultrasonography was clear and the blood supply was clearly discernible. No obvious peripheral blood flow imaging was seen around the renal artery. The tumor was completely resected around 0.5 ~ 1.0 cm along the edge of the tumor. No intraoperative conversion was performed during the operation. Ultrasound endoscopic operation time of 5 min. Postoperative pathology prompted angiomyolipoma, negative margin. Conclusions In 1 case of laparoscopic nephrotic nephron sparing nephron surgery, the location of tumor and the blood supply of tumor were evaluated successfully by ultrasound endoscopy, which provided a basis for radical resection of the neoplasm. It deserved to be further studied in order to facilitate clinical promotion.