CTA对于后腹腔镜下肾部分切除术的指导意义  

The guiding significance of CTA for retrolaparoscopic partial nephrectomy

作　　者：刘勇岐 李峰 赵旭 雒启东[1] 陈琦[1] 南宁[1] 李洪亮[1] 陈海文[1] LIU Yongqi;LI Feng;ZHAO Xu;LUO Qidong;CHEN Qi;NAN Ning;LI Hongliang;CHEN Haiwen(the Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,China)

机构地区：[1]西安交通大学第二附属医院,陕西西安710004

出　　处：《临床医学研究与实践》2024年第12期39-42,47,共5页Clinical Research and Practice

基　　金：国家自然科学基金资助项目(No.82100812);陕西省自然科学基础研究计划项目(No.2020JQ-544)。

摘　　要：目的探讨计算机体层摄影血管造影(CTA)对肾动脉、肾静脉变异的评估价值及其对后腹腔镜下肾部分切除术的指导意义。方法回顾性分析2015年9月至2022年6月于本院行后腹腔镜下肾部分切除术患者的临床资料,根据是否行CTA检查将其分为对照组(47例,术前行常规检查)和观察组(77例,术前行常规检查+CTA)。比较两组的手术效果。结果观察组的手术时间、肾动脉阻断时间短于对照组,术中出血量少于对照组(P<0.05)。124例患者中,50例患者存在肾动脉变异,其中36例通过术前CTA发现,2例是观察组在手术过程中发现,其余12例均为对照组在手术过程中发现;CTA诊断肾动脉变异的准确率为94.74%。19例患者存在肾静脉变异,均通过术前CTA发现且在术中得到确认;CTA诊断肾静脉变异的准确率为100.00%。两组患者的术后并发症总发生率、术后引流时间、术后住院时间无显著差异(P>0.05);术后,两组患者的尿素氮、血肌酐水平均低于术前,且观察组低于对照组(P<0.05)。结论CTA可清楚地观察到肾变异血管的分支走行,弥补普通CT图像对于血管成像方面的不足,为手术方案选择节省时间,并减少术中大出血的可能。但在少部分患者中,CTA不能体现真实的肾动脉情况,所以需要通过完善术前检查以及制定个体化手术方案来减少术中意外的发生。Objective To explore the value of computed tomography angiography(CTA)in valuating renal artery and renal vein variation as well as its guiding significance for retrolaparoscopic partial nephrectomy.Methods The clinical data of patients who underwent retrolaparoscopic partial nephrectomy in our hospital from September 2015 to June 2022 were retrospectively analyzed.According to whether CTA examination was performed,the patients were divided into control group(47 cases,routine examination before surgery)and observation group(77 cases,routine examination before surgery+CTA).The surgical effects of the two groups were compared.Results The operation time and renal artery blocking time of the observation group were shorter than those of the control group,and the intraoperative blood loss was less than that of the control group(P<0.05).Among the 124 patients,50 patients had renal artery variation,of which 36 cases were found by preoperative CTA,2 cases were found during surgery in the observation group,and the remaining 12 cases were found during surgery in the control group;the accuracy of CTA in diagnosing renal artery variation was 94.74%.Renal vein variation existed in 19 patients,all of which were detected by preoperative CTA and confirmed during operation;the accuracy of CTA in diagnosing renal vein variation was 100.00%.There were no significant differences in the total incidence of postoperative complications,postoperative drainage time and postoperative hospital stay between the two groups(P>0.05);after operation,the levels of urea nitrogen and serum creatinine in both groups were lower than those before operation,and those in the observation group were lower than the control group(P<0.05).Conclusion CTA can clearly observe the branch movement of the renal vascular variation,supplement the deficiency of conventional CT images in vascular imaging,save time for the selection of surgical protocols,and reduce the possibility of massive bleeding during the operation.However,in a small number of patients,CTA can not

关 键 词：肾癌 腹腔镜手术 计算机体层摄影血管造影 肾血管变异 

分 类 号：R737.11[医药卫生—肿瘤]