摘要
目的评价IQQA三维立体成像导航技术支持下最大限度保留肾门结构的肾门肿瘤腹腔镜下肾部分切除术的可行性与有效性。
方法回顾性分析2016年2月至2017年2月收治的11例肾门肿瘤患者的临床资料。男7例，女4例。年龄38～70岁，平均51岁。体重指数16.4～28.8 kg/m2，平均22.9 kg/m2。肿瘤最大径1.7～4.3 cm ，平均3.1 cm。肿瘤分期：T1a期9例，T1b期2例。R.E.N.A.L评分7～10分，平均8.7分。术前患肾GFR 32～45 ml/min，平均40.6 ml/min。所有患者术前均行肾动脉CT血管造影检查，将获得的原始二维Dicom图像按顺序导入IQQA－3D术前评估和治疗计划辅助分析系统进行全定量三维重建，在此基础上进行分析，明确肾门解剖结构、肿瘤血供等情况。将分析结果用于术中导航。在行机器人手术时，将重建影像导入机器人手术系统，与手术图像同屏显示，指导肾部分切除术中肿瘤的精准定位和切除。记录手术时间、热缺血时间、术中出血量、肿瘤切缘情况、肾功能、肿瘤复发及转移等指标。
结果11例手术均顺利完成，无中转开放手术。根据术前IQQA三维立体成像结果，11例术中均一次性准确找到肿瘤。手术时间90～230 min，平均142 min。热缺血时间17～33 min，平均24 min。术中出血量50～400 ml，平均156 ml。1例术后出现肉眼血尿，膀胱持续冲洗后自行好转；1例术后血红蛋白显著降低，予输血后恢复良好。11例术后病理检查均确诊为肾透明细胞癌。11例均未发现血管损伤、切缘阳性等并发症。术后随访3个月，患肾GFR 13～34 ml/min，平均22.5 ml/min。11例均无肿瘤复发或转移。
结论在肾门肿瘤精准保肾手术中采用IQQA三维立体成像导航技术，具有肿瘤定位准确、切除完整、围手术期并发症发生率低等优势，是一种安全可行的治疗方法。
ObjectiveTo evaluate the feasibility and effectiveness of the application of IQQA （Intelligent/interactive Qualitative and Quantitative Analysis） three-dimensional reconstruction technique in precise laparoscopic or robot-assisted laparoscopic partial nephrectomy （LPN or RAPN） for renal hilar tumors.
MethodsThe study retrospectively reviewed 11patients with hilar tumors from February 2016 to February 2017. Of the 11 patients, 4 were women and 7 were men, with an average age of 51 years （range 38 to 70 years）. The average tumor size was 3.1 cm （range 1.7 to 4.3 cm）. For tumor stage, 9 patients were in T1a stage and 2 patients were in T1b stage. The average R. E.N.A.L score was 8.7 （range 7 to 10）. The mean preoperative GFR was 40.6 ml/min （range 32 to 45 ml/min）. IQQA three-dimensional reconstruction technique was applied for the purpose of precise navigation and resection of the tumors. Multivariate analysis was used to identify predictors of warm ischemia time, estimated blood loss, major perioperative complications, and postoperative renal function.
ResultsAll 11 laparoscopic or robot-assisted laparoscopic hilar partial nephrectomies were successfully completed without conversion to a hand-assisted or an open approach. Under the navigation of IQQA, all tumors were found precisely at the first time during surgeries. The final pathologic examination revealed that all the 11 patients were clear cell renal cell carcinomas. The mean operative time was 142 minutes （range 90 to 230 minutes）, with a mean warm ischemia time of 24 minutes （range 17 to 33 minutes）. The estimated blood loss was 146 ml （range 50 to 400 ml）. No intraoperative complications occurred. Two patients suffered from postoperative complications. One patient with gross hematuria was recovered by consistent bladder irrigation. The other patient with postoperative hemorrhage needed transfusion. All patients had negative margins on the final pathologic examination. At a mean follow-up period of 3 months, the mean GRR is 22.5 ml/min （range 13 to 34 ml/min） without any disease recurrence.
ConclusionsWith peculiar features, such as accurate location, complete resection and fewer perioperative complications, the application of IQQA three-dimensional reconstruction technique in precise partial nephrectomy represents a safe and effective procedure for hilar tumors.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2017年第7期493-497,共5页
Chinese Journal of Urology
关键词
肾细胞癌
肾门肿瘤
肾部分切
三维立体成像
术中导航
Renal cell carcinoma
Renal hilar tumor
Partial nephrectomy
Three-dimensional reconstruction
Surgery navigation
