MSCT增强检查对腹腔镜下肾肿瘤切除的临床应用价值  

Clinical Application Value of MSCT Enhanced Examination in Laparoscopic Resection of Renal Tumor

作　　者：熊亮[1] 邹文远[1] 李胜[1] 徐官珍[1] 胡久明[1] 杨茜茜[1] 张秋楠[1] 

机构地区：[1]湖北医药学院附属人民医院放射科,十堰442000

出　　处：《临床放射学杂志》2016年第9期1398-1402,共5页Journal of Clinical Radiology

基　　金：十堰市科技局资助(编号:15Y47)

摘　　要：目的探讨MSCT增强联合CT血管成像（CTA）技术在腹腔镜下肾肿瘤切除术中的临床应用价值。方法回顾性分析29例经腹腔镜切除的肾肿瘤患者术前行MSCT联合CTA检查资料,采用多平面重组（MPR）、最大密度投影（MIP）、容积再现（VR）等计算机重建技术按照PADUA评分系统评估肾脏肿瘤的位置、血供、肿瘤与集合系统的关系以及肾脏血管系统,分析肾肿瘤解剖结构与腹腔镜下肾肿瘤切除术式之间的关系。结果按照PADUA评分系统显示,肿瘤的纵向位置位于上/下极20例,中部9例;肿瘤位于肾脏外侧缘23例,内侧缘6例;肿瘤外凸率≥50%14例,〈50%12例,完全内陷3例;与肾窦有关9例,与肾窦无关20例;与集合系统有关20例,与集合系统无关9例;肿瘤最大径≤4 cm 11例,4.1～7 cm 10例,〉7 cm 8例。结果行后腹腔镜肾根治切除术（LRN）18例,评分显示≥9分;行后腹腔镜下肾部分切除术（LPN）11例,评分显示为≤8分。同时发现双支肾动脉5例,肾动脉走行变异1例;肾静脉瘤栓形成1例,淋巴结转移2例,1例肾静脉胡桃夹征。结论 MSCT增强检查特别是肾动脉CTA能够清晰显示肾血管的起源、走行、变异及发现副肾动脉,清楚显示肿瘤与肾脏血管系统、集合系统的关系以及肿瘤的载瘤动脉,对腹腔镜下肾肿瘤切除术式的选择以及减少术后并发症具有重要的临床指导价值。Objective To investigate the clinical application value of MSCT enhanced scan combined with CT angiography in laparoscopic renal tumor resection. Methods 29 patients with renal tumors who underwent laparoscopic resection were retrospectively analyzed. MSCT combined with CTA imaging was performed before and after operation. The MPR score system was used to evaluate the location,blood supply,tumor,collection system and renal vascular system with the PADUA scoring system. The relationship between anatomic structure of renal tumor and laparoscopic resection of renal tumor was assessed. Results According to the PADUA scoring system it was shown that the longitudinal position of the tumor was located on lower part of the kidney in 20 cases,middle in 9 cases; tumors located in the lateral margin of the kidney in23 cases,6 cases in the medial margin; tumor convex rate is more than or equal to 50% in 14 cases. tumor convex rate was less than 50% in 12 cases,completely invaginated in 3 case and renal sinus in 9 cases. 20 cases did not involve the renal sinus; 20 cases were in the collecting system,and 9 cases did not involve the collecting system independent. Maximum tumor diameter was less than or equal to 4 cm in 11 cases,4. 1 to 7cm in 10 cases and more than 7cm in 8 cases. Results After laparoscopic radical resection（ LRN） in 18 cases,the score is equal to or more than nine points; retroperitoneal laparoscopic partial nephrectomy（ LPN） of 11 cases＇ score display is less than or equal to 8 points. We also found that there were double renal arteries in 5 cases,1 case of renal artery morphological variation; renal vein tumor thrombus formation in 1 case,lymph node metastases were found in 2 cases and 1 case of renal vein walnut clip Conclusion enhanced MSCT examination and especially renal artery CTA can clearly show the renal vascular origin,shape,variation and locate an accessory renal artery. It can clearly indicate the tumor and renal vascular system relations,set system and tumoral aneurysms and therefore a

关 键 词：肾肿瘤 解剖特征 肾部分切除术 多层螺旋CT血管成像 

分 类 号：R737.11[医药卫生—肿瘤] R730.44[医药卫生—临床医学]