肾段动脉阻断肾部分切除术的相关尸肾解剖研究  

Cadaveric renal anatomic study of partial nephrectomy with segmental renal artery clamping

作　　者：朱华[1] 郑兵[1] 茅家慧[2] 潘晓东[1] 顾栋华[1] 陈建刚[1] 陆明[1] 张冰[1] 钱麟[1] 

机构地区：[1]南通大学第二附属医院泌尿外科,226001 [2]南通大学医学院病理生理教研室

出　　处：《中华泌尿外科杂志》2013年第8期587-590,共4页Chinese Journal of Urology

基　　金：2010年南通大学自然科学类科研基金项目（102081）;2012年南通市级科技计划项目（HS12961）

摘　　要：目的通过研究肾动脉、肾段动脉的解剖分布特点及其与肾门的关系，为临床开展肾段动脉阻断下肾部分切除术提供解剖依据。方法2010年至2012年，选取成年尸肾解剖标本22对，对肾动脉和各段动脉及副肾动脉进行解剖分析，分别测量肾动脉一级分支处和二级分支处与肾门上下缘连线（A线）的距离，并行左右侧比较，观察副肾动脉出现率及其起源和支配情况。结果肾动脉一级分支处距A线（1．0±0．7）cm，二级分支处距A线（0．4±0．3）cm，左右侧比较差异无统计学意义（P〉0．05）。一级分支处在肾门A线外侧者占多数，为90．9％（40／44）。二级分支处多数在A线外侧，占52．3％（23／44），位于A线内侧者36．4％（16／44）。副肾动脉出现率31．8％（14／44），其中一支型13例、二支型1例，起自肾动脉11例，支配肾上极者13例。结论肾动脉呈节段性分布，肾段动脉与肾门之间存在一定的空间，肾段动脉阻断的肾部分切除术是安全可行的。副肾动脉出现率较高，大部分支配肾上极，行肾段动脉阻断的肾部分切除术时应注意保护副肾动脉，避免不必要的肾单位损伤。Objective To study the anatomic characteristics of the renal artery and segmental renal artery and their relationship with the renal hilum in order to provide a theoretical basis for partial nephrectomy with segmental renal artery clamping. Methods From 2010 to 2012, 22 pairs of adult cadaveric renal specimen via conventional anti-corrosion were adopted for the research. The distance between the first branch of renal artery and the secondary branch to the line A （ Line A connects upper and lower pole of the renal hi- lum） and the distance between the two branches were measured, and comparison was made between left and right kidney respectively. The location and dominance of the accessory renal artery were analyzed. Results The average distance between the first branch and the line A was （1.0＋0.7） cm, and the distance between the secondary branch and Line A was （0.4＋0.3） cm, and there was no significant difference between left and right side （P〉0.05）. The cases with the first branch outside the line A was 90.9% （40/44）. There were 23 cases with secondary branch outside the line A （52.3%, 23/44） , and 16 cases with secondary branch inside the line A （36.4%, 16/44）. 31.8% of the cases had accessory renal artery, among which one case had two accessory arteries. Eleven accessory arteries originated from the renal artery, while 13 accessory arteries dominated the upper pole of kidney. Conclusions The renal artery showed segmental distribution, and there was enough space between the renal artery and the renal hilum. This finding further clarifies that partial nephrectomy with segmental renal artery clamping could be safe and feasible. Accessory renal arteries arise with certain possibility, and most dominate in the upper pole of kidney. So intraoperative attention should be paid to avoid unnecessary nephron loss.

关 键 词：肾部分切除术 肾段动脉 肾门 副肾动脉 解剖学 局部 

分 类 号：R699.2[医药卫生—泌尿科学] R322[医药卫生—外科学]