多层螺旋CT血管成像在后腹腔镜肾脏切除手术中的应用价值

目的：探讨术前多层螺旋CT血管成像技术在后腹腔镜下。肾脏切除手术中的指导意义。方法：45例患者术前行64排螺旋CT血管成像检查，明确肾血管与病肾及病灶的三维解剖关系，并在其指导下，行根治性肾切除术14例，’肾部分切除术7例，其中肾段动脉阻断的肾部分切术2例；肾输尿管膀胱袖状切除7例，单纯性肾切除16例，上肾单位切除1例。结果：多层螺旋CT血管成像提示动脉解剖异常占26．7％，动脉病变占6．7％。静脉解剖异常占22．4％，所提示的血管解剖异常及病变与术中所见吻合率100％，但术中发现异常的肾肿瘤静脉血管，在螺旋CT血管成像中未能清晰显示占6．7％。在多层螺旋CT血管成像的提示下，术中病肾血管的处理快速准确，手术顺利。术中平均出血80ml，手术平均时间170min，无中转开放手术。结论：术前行多层螺旋CT血管成像检查，可直观准确地评估血管。特别是动脉血管与病肾及病灶的三维解剖关系，了解可能存在的动静脉解剖变异或血管病变，拟定手术方案，指导术者快速准确地处理血管，避免盲目操作，减少出血和并发症。在后腹腔镜的肾脏切除手术中．有较重要的价值。

Clinical Value of Multi-Slices Spiral CT Angiography in Retroperitoneal Laparoscopic Nephrectomy

Objective:To study the guiding value of pre-operative multi-slices spiral CT angiography in retroperitoneal laparoscopic nephrectomy.Methods:This study was comprised of 15 cases.Pre-operative 64-row spiral CT angiography was applied to define anatomical relationship in three-dimension format among renal blood vessels, disordered kidney and lesion,and under its guidance,14 cases underwent radical nephrectomy.7 cases underwent partial nephrectomy,in which 2 cases underwent retroperitoneal laparoscopic partial nephrectomy with selective blockage to renal segmentary artery.7 cases underwent resection of kidney and ureter along with cuff partial cys tectomy.16 cases underwent simple nephrectomy,1 case underwent resection of upper nephron.Result:Multislices spiral CT angiography indicated that anatomical abnormality of artery was 26.7%.artery disorder was 6. 7%.anatomical abnormality of vein was 22.4%,the conformity ratio between vessel’s anatomical abnormality and disorder being indicated by multi-slices spiral CT angiography and what being found in actual operation was 100%. however,the ratio for the abnormal vein to renal tumor found in operation being unable to be clearly indicated in spiral CT angiography imaging was 6.7%.The vessels for the disordered kidney were handled swiftly and accurately in operation under the guidance of imaging from the multi-slices spiral CT angiography.Intra-operative average blood loss was 80ml,the average operative duration was 170 minutes,none of the operations was converted to open surgery.Conclusion:Pre-operative multi-slices spiral CT angiography is able to directly and accurately evaluate blood vessel,especially anatomical relationship in three-dimension format among artery,disordered kidney and lesion,guide surgeon to handle blood vessel swiftly and accurately,reduce blood amount and decrease complications, it bears great value to retroperitoneal laparoscopic nephrectomy.