摘要
目的探讨CT血管成像（CTA）在腹腔镜肾部分切除术中评估血管的临床应用价值。方法自2010年5月至2014年10月,32例肾肿瘤（直径〈4 cm）患者在东莞市人民医院行腹腔镜肾部分切除术。术前常规行CT血管成像,放射科医师和手术医师术前通过CT血管成像图像对肾血管进行评估。观察手术时间、热缺血时间、失血量、术后并发症及临床复发情况。结果 32例患者成功进行腹腔镜肾部分切除术,无中转开放手术者。CTA可以清晰显示肾动脉变异、肾动脉及其分支的分布情况,通过术前CT图像发现2支副肾动脉,其中9例行腹腔镜选择性肾血管阻断肾部分切除术,CTA对肿瘤血供动脉评估准确率为88.9%。平均手术时间为（89.0±9.8）min,平均热缺血时间（25.0±3.4）min,平均术中失血量（145.2±16.1）ml,无需输血者。病理回报27例肾透明细胞癌,1例肾乳头状细胞癌,4例肾血管平滑肌脂肪瘤。随访3~49个月,无临床复发。结论 CT血管成像能准确描述肾血管,可作为腹腔镜肾部分切除术指导处理血管的重要影像检查之一。
Objective To investigate the clinical value of computed tomography angiography（CTA）in evaluating renal artery during laparoscopic partial nephrectomy（LPN）. Methods From May of 2010 to October of 2014, 32 patients with renal masses（〈4 cm） who underwent laparoscopic partial nephrectomy were enrolled in this study. Computed tomography angiography was preoperatively performed, renal arterial anatomy were evaluated with computed tomography angiography by radiologist and surgeon individually.The operation time, warm ischaemia time, blood loss, postoperative complications and clinical relapse were recorded. Results Thirty-two patients successfully underwent laparoscopic partial nephrectomy without intraoperative conversion. Renal arterial anatomy was accurately depicted with computed tomography angiography, two reanl accessory arteries were observed preoperatively on CT angiography images. Nine patients successfully underwent laparoscopic partial nephrectomy with superselective clamping of renal arterial branches, accuracy of CT angiography to detect the renal tumour-feeding branches was 88.9%. The average operative time was（89.0 ±9.8） min, the average warm ischaemia time was（25.0 ±3.4） min, the intraoperative blood loss was（145.2 ±16.1） ml, no blood transfusion occurred. Pathological examinations showed that 27 cases were clear cell carcinoma, 1 papillary cell carcinoma and 4 angiomyolipoma. No clinical relapse was observed during the 3-49 months follow-up period. Conclusion CT angiography can accurately depict renal vascular anatomy, the use of CT angiography may be a viable alternative to guide renal artery clamping during LPN.
出处
《中华腔镜泌尿外科杂志（电子版）》
2016年第2期14-17,共4页
Chinese Journal of Endourology(Electronic Edition)
基金
广东省东莞市高等院校
科研机构和医疗卫生单位科技计划重点项目(2012105102027)
关键词
血管
腹腔镜
肾切除术
肾肿瘤
Blood vessels
Laparoscopy
Nephrectomy
Kidney tumor
