Su Tianhao, Zhang Zhiyuan, Zhao Meishan, Hao Gangyue, Tian Ye, Jin Long
Department of Interventional Radiology, Affiliated Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Department of Urology Surgery, Affiliated Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Front Oncol. 2022 Jul 12;12:916787. doi: 10.3389/fonc.2022.916787. eCollection 2022.
Small, totally endophytic renal masses present a technical challenge for surgical extirpation due to poor identifiability during surgery. The method for the precise localization of totally endophytic tumours before nephron-sparing surgery could be optimized. An asymptomatic 70-year-old male presented with a right-sided, 16-mm, totally endophytic renal mass on computed tomography (CT). CT-guided percutaneous microcoil localization was carried out prior to laparoscopy to provide a direction for partial nephrectomy. During the 25 minutes of the localization procedure, the patient underwent five local CT scans, and his cumulative effective radiation dosage was 5.1 mSv. The span between localization and the start of the operation was 15 hours. The laparoscopic operation time was 105 minutes, and the ischaemia time was 25 minutes. The postoperative recovery was smooth, and no perioperative complications occurred. Pathology showed the mass to be renal clear cell carcinoma, WHO/ISUP grade 2, with a 2-mm, clear surgical margin. The patient remained free of recurrence on follow-up for eleven months. To our knowledge, this application of microcoil implantation prior to laparoscopic partial nephrectomy towards an intrarenal mass could be an early reported attempt for the localized method applied in renal surgery. The percutaneous microcoil localization of endophytic renal tumours is potentially safe and effective prior to laparoscopic partial nephrectomy.
由于手术中难以识别，小的完全内生性肾肿块的手术切除面临技术挑战。保留肾单位手术前完全内生性肿瘤的精确定位方法有待优化。一名70岁无症状男性，计算机断层扫描（CT）显示右侧有一个16毫米的完全内生性肾肿块。在腹腔镜检查前进行了CT引导下经皮微线圈定位，为部分肾切除术提供方向。在25分钟的定位过程中，患者接受了5次局部CT扫描，累积有效辐射剂量为5.1毫希沃特。定位与手术开始之间的间隔为15小时。腹腔镜手术时间为105分钟，缺血时间为25分钟。术后恢复顺利，未发生围手术期并发症。病理显示肿块为肾透明细胞癌，WHO/ISUP 2级，手术切缘清晰，为2毫米。患者随访11个月无复发。据我们所知，这种在腹腔镜部分肾切除术之前对肾内肿块应用微线圈植入的方法可能是肾手术中局部化方法的早期报道尝试。在腹腔镜部分肾切除术之前，经皮微线圈定位内生性肾肿瘤可能是安全有效的。
