Assimos D G, Boyce H, Woodruff R D, Harrison L H, McCullough D L, Kroovand R L
Department of Urology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina.
J Urol. 1991 Nov;146(5):1218-20. doi: 10.1016/s0022-5347(17)38050-3.
Several evolutionary changes in ultrasonographic instrumentation, including miniaturization of transducers and marked improvement in resolution, have made intraoperative renal ultrasonography a valuable adjunct for intrarenal surgery. We investigated its use in 6 patients undergoing partial nephrectomy for treatment of renal cell carcinoma. In addition, 14 kidneys with renal tumors were scanned immediately after radical nephrectomy and the specimens were subjected to simulated partial nephrectomy. Transverse and longitudinal real-time sonographic images were obtained with a 5 MHz. sector scanner or a 7.5 MHz. convex array transducer. With ultrasonography to define tumor extent and location, negative surgical margins were obtained in all 6 individuals undergoing partial nephrectomy. A negative surgical margin was obtained in 13 of the 14 radical nephrectomy specimens subjected to simulated partial nephrectomy. A small satellite lesion was not identified and not resected in 1 of the radical nephrectomy specimens. We found that intraoperative renal ultrasonography helps to identify the location and extent of deep intraparenchymal lesions. It also provides a guide for a more accurate nephrotomy, which facilitates the attainment of negative resection margins during partial nephrectomy.
超声检查设备的多项进化变革，包括换能器的小型化以及分辨率的显著提高，已使术中肾脏超声检查成为肾内手术的一项重要辅助手段。我们对6例因肾细胞癌接受部分肾切除术的患者使用了该检查。此外，对14个患有肾肿瘤的肾脏在根治性肾切除术后立即进行扫描，并对标本进行模拟部分肾切除术。使用5兆赫扇形扫描仪或7.5兆赫凸阵换能器获取横向和纵向实时超声图像。通过超声检查确定肿瘤范围和位置，6例接受部分肾切除术的患者均获得了阴性手术切缘。在14个接受模拟部分肾切除术的根治性肾切除标本中，有13个获得了阴性手术切缘。1个根治性肾切除标本中未识别出一个小的卫星病灶且未予切除。我们发现术中肾脏超声检查有助于识别实质内深部病变的位置和范围。它还为更精确的肾切开术提供指导，这有助于在部分肾切除术中获得阴性切除切缘。
