CTA在腹腔镜下行亲属肾移植供体取肾术中肾血管处理的应用价值  

Application of CTA for renal vascular control in laparoscopic renal transplantation of relative renal donors

作　　者：吴荣华[1] 黄赤兵[1] 冯嘉瑜[1] 陈益荣[1] 李明洋[1] 李旺[1] 

机构地区：[1]第三军医大学新桥医院泌尿外二科,重庆400037

出　　处：《局解手术学杂志》2014年第5期519-521,共3页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的探讨CT血管造影(CTA)在腹腔镜下行亲属肾移植供体取肾术中肾血管处理的应用价值。方法将2007年3月至2012年1月我科完成的亲属肾移植供体取肾术共计83例分为3组,A组35例,术前行CTA检查并行腹腔镜下取肾术;B组15例,术前不行CTA检查行腹腔镜下取肾术,C组33例行传统开放取肾术。A组术前行CTA观察供肾动静脉血管位置、数量,制定术中血管处理预案,与B组和C组分别比较手术时间、术中出血量、术中血管损伤例数、供肾热缺血时间、供体术后平均住院日。结果 A组术前检查发现肾血管异常5例:2例1支副肾动脉;2例肾动脉早期分支;1例双支肾静脉,术中证实术前CTA对肾血管异常的诊断正确率达100%。B组肾血管异常3例:1例肾动静脉异位;1例误断内径约0.6 cm副肾动脉,术后取腹壁下动脉行动脉延长术;1例用Hemolock阻断腰静脉时损伤肾静脉,术后修补。C组肾血管异常5例:1例1支副肾动脉;3例肾血管早期分支;1例1支内径约0.1 cm右肾副下极动脉,术中损伤,结扎废弃。A组在手术时间、术中出血量、术中血管损伤例数、供肾的热缺血时间、供体术后平均住院日方面明显优于B组和C组。结论 CTA作为一种简单无创的影像学检查方法,能在术前提供详细的肾血管解剖情况,对保证手术顺利进行、提高供肾的存活质量有重要意义,在腹腔镜下行亲属肾移植供肾取肾术中有较价高的应用值。Objective Discuss the application of CTA for renal vascular control in laparoscopic renal transplantation of relative renal donors. Methods 83 cases of relative renal transplantation donors which are completed in our department during March 2007 to Junuary 2012 were divided into 3 Groups. There were 35 cases in group A （ laparoscopic nephrectomy with preoperative CTA examination） , 15 cases in group B （ laparoscopic nephrectomy without preoperative CTA examination） , and 33 cases group C （ conventional nephrectomy） . In group A, the location and quantity of renal arteries and veins were observed with preoperative CTA to make plan for vascular control. And the oper-ation time, amount of bleeding, vascular injury cases, the renal warm ischemia time in the graft, mean time of postoperative hospitalization were compared with those of group B and group C. Results 5 cases of renal vascular anomalies were observed in Group A, including 2 cases of single accessory renal artery, 2 cases of early branch of renal artery and 1 case of double renal veins. And all of them were intraoperatively comfirmed. 3 cases of renal vascular anomalies were observed in group B, including 1 case of renal arteriovenous ectopic, 1 case of injury in the accessory renal artery with diameter of 0. 6 cm, and it were given artery elongation with inferior epigastric artery postoperatively, and 1 case of renal vein injure during blocking lumbar vein with Hemolock which were repaired postoperatively. 5 cases of renal vascular anomalies were observed in group C, including 1 case of single accessory renal artery, 3 cases of early branch of renal artery, and 1 case of accessory renal artery with the diameter of 0. 1cm in the right renal was injured during surgery. The operation time, amount of bleeding, cases with vascular injury , renal warm ischemia time of donor , and the mean time of postoperative hospitalization in group A were superior to those in＆amp;nbsp;group B and group C. Conclusion CTA is a simple noninvasive imaging method, wh

关 键 词：CTA 腹腔镜 亲属肾移植 

分 类 号：R699.2[医药卫生—泌尿科学]