Polascik T J, Meng M V, Epstein J I, Marshall F F
Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
J Urol. 1995 Nov;154(5):1676-80.
Intraoperative sonography was used to evaluate prospectively the renal parenchyma of patients undergoing surgery for presumed renal neoplasia.
One surgeon (F.F.M.) evaluated 100 kidneys using a triple-head sector ultrasonic transducer (5 MHz., 7.5 MHz. and 10 MHz. with duplex Doppler imaging). The size, number, echo texture, location, and relationship of suspected lesions to the collecting system, vasculature and renal capsule were recorded. Real-time Doppler imaging was used to distinguish among renal arteries, renal veins and the collecting system. Sonography was used to delineate the extent of the tumor and presence or absence of satellite lesions. All patients were evaluated preoperatively with abdominal computerized tomography.
Under ultrasonic guidance partial nephrectomy was done in 40 cases, radical nephrectomy in 56, unroofing of renal cysts in 3 and renal biopsy in 1. Of the patients 8 were considered candidates for partial nephrectomy but underwent radical nephrectomy after intraoperative sonography revealed more extensive tumor, especially at the renal hilum. Similarly, 3 patients with a suspected malignancy were spared nephrectomy after intraoperative sonography and frozen section analysis revealed benign multilocular cysts. All surgical margins after sonographic evaluation were negative in patients undergoing partial nephrectomy.
Intraoperative ultrasound is a useful adjunct for the dynamic evaluation of renal tumors in the surrounding environment of renal cysts, the collecting system and the renal vasculature. It is particularly beneficial in defining preoperative indeterminate renal lesions and in evaluating extrarenal structures for tumor involvement, such as the renal vein, inferior vena cava, adrenal gland and liver. Intraoperative sonography is most useful during partial nephrectomy and may improve tumor-free surgical margins. Sonography is routinely used during partial nephrectomy.
前瞻性地应用术中超声检查评估疑似肾肿瘤患者的肾实质。
一名外科医生（F.F.M.）使用三头扇形超声换能器（5兆赫、7.5兆赫和10兆赫，具备双功多普勒成像）对100个肾脏进行评估。记录可疑病变的大小、数量、回声质地、位置以及与集合系统、脉管系统和肾包膜的关系。使用实时多普勒成像区分肾动脉、肾静脉和集合系统。超声检查用于描绘肿瘤范围以及有无卫星病灶。所有患者术前均接受腹部计算机断层扫描评估。
在超声引导下，40例行部分肾切除术，56例行根治性肾切除术，3例行肾囊肿去顶术，1例行肾活检。8例患者原被认为适合行部分肾切除术，但术中超声显示肿瘤范围更广，尤其是在肾门处，故改行根治性肾切除术。同样，3例疑似恶性肿瘤的患者在术中超声及冰冻切片分析显示为良性多房囊肿后，免于肾切除术。接受部分肾切除术的患者经超声评估后所有手术切缘均为阴性。
术中超声是在肾囊肿、集合系统和肾脉管系统的周围环境中对肾肿瘤进行动态评估的有用辅助手段。它在明确术前不确定的肾脏病变以及评估肾外结构如肾静脉、下腔静脉、肾上腺和肝脏是否受肿瘤侵犯方面特别有益。术中超声在部分肾切除术中最有用，可能会改善无瘤手术切缘。部分肾切除术中常规使用超声检查。
