Walther M M, Choyke P L, Hayes W, Shawker T H, Alexander R B, Linehan W M
Urologic Oncology Section, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
J Urol. 1994 Dec;152(6 Pt 1):1984-7. doi: 10.1016/s0022-5347(17)32285-1.
A renal parenchymal sparing surgical approach may be recommended in select patients with von Hippel-Lindau disease and renal cancer or in those with sporadic renal cancer and limited normal renal function. We performed 27 partial nephrectomies or enucleations in 17 patients with the use of intraoperative ultrasound to examine a subset of all renal lesions identified on preoperative examination. Of 24 lesions deep in the renal parenchyma that were examined, localized or identified with intraoperative ultrasound 18 were characterized as cystic and 6 as solid. The deep cystic lesions were characterized with ultrasound as benign simple cysts. Intraoperative ultrasound was used to locate and mark the line of incision over 2 impalpable solid renal cell carcinomas. Four solid renal cell tumors extended deep into the renal parenchyma where color Doppler intraoperative ultrasound helped to define the plane of dissection adjacent to vital vascular structures. Renal hypothermia was not used in 3 renal operations based on intraoperative ultrasound findings.
对于患有希佩尔-林道病和肾癌的特定患者，或患有散发性肾癌且肾功能正常范围有限的患者，可能推荐采用保留肾实质的手术方法。我们对17例患者进行了27次部分肾切除术或肿瘤剜除术，术中使用超声检查术前检查发现的所有肾病变的一个子集。在检查的24个位于肾实质深部的病变中，术中超声定位或识别出18个为囊性病变，6个为实性病变。深部囊性病变经超声检查为良性单纯囊肿。术中超声用于定位并标记2个无法触及的实性肾细胞癌的切口线。4个实性肾细胞肿瘤深入肾实质深部，术中彩色多普勒超声有助于确定与重要血管结构相邻的解剖平面。基于术中超声检查结果，3例肾脏手术未采用肾低温技术。
