腹腔镜肾部分切除术(二)
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Using a steerable, flexible, colour-Doppler ultrasound probe introduced through a 10/12-mm port and positioned in direct contact with the surface of the kidney, information is obtained on tumour size, depth of intraparenchymal extension, distance of tumour from the pelvicalyceal system, the presence of any satellite tumour possibly missed on preoperative CT, and visualization of large intrarenal vessels.
将可控活动的彩色多普勒超声探针置入10/12mm通道并直接接触定位到肾脏表面，从而获得肿瘤体积，实质内深度，肿瘤距肾盂肾盏系统的距离，术前CT可能忽略存在的卫星肿瘤病灶，以及可看清大的肾内血管。
Using the tip of the monopolar J-hook electrocautery, the proposed line of excision is circumferentially scored on the renal capsule around the tumour under real-time US guidance.
用单极J钩电烙器头端，切除的预定线为围绕实时US监测肿瘤边缘的肾包膜的压痕。
En bloc hilar clamping provides a near bloodless surgical field, which is necessary to achieve technically precise tumour excision, and collecting system and parenchymal repair. The tip of the suction cannula allows atraumatic, blunt and gentle dissection of the posterior aspect of the renal hilum, carefully avoiding any lumbar vessels in this area. A Satinsky clamp, inserted through the suprapubic port is placed across the hilum, medial to the ureter and renal pelvis to prevent urothelial crush injury. The duration of warm ischaemia is monitored using a stopwatch.
肾门的整体夹紧可提供一个近乎无血的手术区域，从而达到技术上精确进行肿瘤切除，并修补收集系统和实质。吸引套管的尖端需要无创伤的，钝圆的并能在肾门后面进行大体解剖分离，在此区域需避免腰血管损伤。Satinsky夹通过耻骨弓上通道置入横跨肾门，在输尿管和肾盂的内侧预防泌尿上皮的挤压伤。在热缺血期间内用秒表进行监测。
Once the renal hilum is clamped, the J-hook electrocautery is used to circumferentially incise the renal capsule.
一旦夹紧肾门，用J钩电烙器在周围切开肾包膜。
The parenchyma is resected using the ‘cold’ reusable endoscissors. Compared with the disposable endoshears, the jaws of the reusable scissors are larger, thereby facilitating tumour excision. The preserved perirenal fat attached to the tumour is grasped and placed on counter-traction to elevate the tumour away from the tumour bed. A clear operative field is achieved by active, intermittent suction of blood from the PN bed. To guide the depth of tumour resection, the surgeon creates a threedimensional mental map of the proposed excision, by collating information from preoperative CT, intraoperative US, and the direct magnified laparoscopic visualization. A parenchymal margin of ≈ 0.5 cm around the tumour is targeted.
用“冷”内镜切割器切除实质。对比一次性内镜剪，这种可重复用的剪口径较大，因此有助于肿瘤切除。抓持附在肿瘤上的肾周脂肪，在对抗牵引力作用下将肿瘤从肿瘤床上提起。一个清楚的手术野通过有效地间歇抽吸从部分肾脏床上的血液得以充分暴露。为引导肿瘤切除的深度，外科医师需通过从术前CT，术前US以及腹腔镜下扩大的视野所得信息构建一个预定切除的三维图。在肿瘤边缘的肾实质切除约0.5公分的切缘。
将可控活动的彩色多普勒超声探针置入10/12mm通道并直接接触定位到肾脏表面，从而获得肿瘤体积，实质内深度，肿瘤距肾盂肾盏系统的距离，术前CT可能忽略存在的卫星肿瘤病灶，以及可看清大的肾内血管。
Using the tip of the monopolar J-hook electrocautery, the proposed line of excision is circumferentially scored on the renal capsule around the tumour under real-time US guidance.
用单极J钩电烙器头端，切除的预定线为围绕实时US监测肿瘤边缘的肾包膜的压痕。
En bloc hilar clamping provides a near bloodless surgical field, which is necessary to achieve technically precise tumour excision, and collecting system and parenchymal repair. The tip of the suction cannula allows atraumatic, blunt and gentle dissection of the posterior aspect of the renal hilum, carefully avoiding any lumbar vessels in this area. A Satinsky clamp, inserted through the suprapubic port is placed across the hilum, medial to the ureter and renal pelvis to prevent urothelial crush injury. The duration of warm ischaemia is monitored using a stopwatch.
肾门的整体夹紧可提供一个近乎无血的手术区域，从而达到技术上精确进行肿瘤切除，并修补收集系统和实质。吸引套管的尖端需要无创伤的，钝圆的并能在肾门后面进行大体解剖分离，在此区域需避免腰血管损伤。Satinsky夹通过耻骨弓上通道置入横跨肾门，在输尿管和肾盂的内侧预防泌尿上皮的挤压伤。在热缺血期间内用秒表进行监测。
Once the renal hilum is clamped, the J-hook electrocautery is used to circumferentially incise the renal capsule.
一旦夹紧肾门，用J钩电烙器在周围切开肾包膜。
The parenchyma is resected using the ‘cold’ reusable endoscissors. Compared with the disposable endoshears, the jaws of the reusable scissors are larger, thereby facilitating tumour excision. The preserved perirenal fat attached to the tumour is grasped and placed on counter-traction to elevate the tumour away from the tumour bed. A clear operative field is achieved by active, intermittent suction of blood from the PN bed. To guide the depth of tumour resection, the surgeon creates a threedimensional mental map of the proposed excision, by collating information from preoperative CT, intraoperative US, and the direct magnified laparoscopic visualization. A parenchymal margin of ≈ 0.5 cm around the tumour is targeted.
用“冷”内镜切割器切除实质。对比一次性内镜剪，这种可重复用的剪口径较大，因此有助于肿瘤切除。抓持附在肿瘤上的肾周脂肪，在对抗牵引力作用下将肿瘤从肿瘤床上提起。一个清楚的手术野通过有效地间歇抽吸从部分肾脏床上的血液得以充分暴露。为引导肿瘤切除的深度，外科医师需通过从术前CT，术前US以及腹腔镜下扩大的视野所得信息构建一个预定切除的三维图。在肿瘤边缘的肾实质切除约0.5公分的切缘。
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作者: 谍影重重
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