MSCTA在活体肾移植供肾切除术前的应用

目的  探讨多层螺旋CT血管成像（MSCTA）在活体肾移植供肾切除术前的应用价值。方法  采用西门子公司双源CT设备对40例受检者行MSCTA检查,评估肾脏血管解剖及变异情况。结果  40例80个肾脏中,MSCTA显示64个肾脏由单支动脉供血、67个肾脏由单支静脉引流、16个肾脏存在副肾动脉、11支主肾动脉存在过早分支、1例左肾上段动脉起始部局限性狭窄、1例肠系膜上动脉起始部局限性狭窄、1例左肾静脉中段见一血管袢。40例受检者中22例行供肾摘除术,术中所见供肾血管情况与MSCTA术前评估结果一致。结论  MSCTA可准确显示受检者肾脏血管情况,可作为活体肾移植供肾术前血管评估的首选检查方法。     

亲属供肾单支动脉与多支动脉的临床疗效比较

 目的 探讨亲属供肾单支血管与多支血管在肾移植临床疗效上有无差异。方法 采用回顾性分析方法统计130例亲属肾移植受体病史资料,采用基本统计方法计算供体肾动脉、静脉变异的发生率,并对受体进行1~5年随访,采用χ²检验比较多支供肾动脉与单支供肾动脉疗效有无差异。结果 供体术前CT血管成像检查（CT angiography,CTA）评估结果发现,32例供体出现副肾动脉,发生率为24.6%,其中双肾副肾动脉10例,发生率为7.7%;肾静脉多支15例,发生率为11.5%,且均为右肾。受体和供肾的1年存活率分别为94.3%和91.5%。单支动脉供肾与多支动脉供肾在肾移植中的临床疗效无明显差异。结论 亲属供肾单支血管与多支血管在肾移植中的临床疗效无差异,且对供体和受体均安全。     

CT血管造影活体供肾术前检查的意义

目的 通过CT肾血管造影在肾移植术前精确测量及评价供体肾脏大小、肾动脉、肾静脉长度、管径以及肾脏排泄功能等所需数据;并通过与手术结果 对比,证明此检查的必要性.方法 回顾性分析100例活体供肾者CT肾血管造影检查.结果 本组100例活体供肾者,共200组动、静脉(左右分别为一组):126例为正常单支肾动脉供血;52例双支动脉供血;22例肾动脉肾门前分支,其开口处分支均大于1.5 cm,18例右肾双支静脉;5例左肾双支静脉并副肾走行于腹主动脉后方汇入下腔静脉;2例肾盂输尿管重复畸形.结论 经CT肾血管造影后所得数据,给予肾移植手术术前准备、供体肾脏选择以及预后评估很大数据支持,并通过对比手术记录,CT肾血管造影诊断符合率为98%,因此CT肾血管造影有必要作为肾移植术前供体的常规检查.     

异常体循环动脉供血正常左肺下叶MSCT表现

目的探讨异常体循环动脉供血正常左肺下叶的MSCT表现。方法收集6例确诊为异常体循环动脉供血正常左肺下叶的影像资料,通过后期图像处理,对异常供血动脉、肺动静脉、支气管及肺实质MSCT表现进行回顾性分析。结果 6例均可见胸降主动脉左侧发出单支粗大异常动脉走行于左下肺静脉后下方,起始处较肺内段窄,血管先下降,后上升,再下降呈"S"形改变,然后发出数个分支,供应左下肺下基底段。6例左肺下叶上段肺动脉均未受累,4例左下肺下基底段肺动脉及其远端缺如,缺如区域由异常体循环动脉供血,2例双重供血,左下肺下基底段肺动脉显示正常。6例均由左下肺静脉引流,3例左下肺静脉受压,远端较近心端膨大。1例粗大异常动脉壁可见钙化。6例受累肺组织支气管结构正常,肺体积缩小,实质呈现磨玻璃密度影,磨玻璃阴影内血管迂曲、血管断面增粗、密集。结论异常体循环动脉供血正常左肺下叶的MSCT有特征性表现,CT增强可以明确诊断。     

亲属活体供肾摘除术前多层螺旋CT血管造影术评价肾血管

目的探讨多层螺旋CT血管造影术（spiral CT angiography,SCTA）对亲属活体供肾摘除术前的肾脏血管进行综合评价的价值。方法对9例供体肾脏进行CT常规全腹部平扫及动脉期增强薄层容积扫描,然后将原始图像传到工作站进行最大密度投影（MIP）、容积再现（VR）、多平面重组（MPR）、曲面重建（CPR）等技术后处理。结果9例中7例供体肾脏为1支肾动脉供血;1例为左肾门前动脉分支（分2支肾动脉）,右侧单支;1例为双肾副肾动脉伴双下腔静脉畸形,右侧较粗伴分支,左侧较细。9例中1例左肾小结石;1例双肾多发小囊肿。结论SCTA相对DSA等有创伤性检查有较大优势,对显示活体供肾血管的解剖、病变和变异有明显优势,可提供足够的术前信息。     

右肾多支肾动脉伴复杂极动脉1例

在局部解剖学实验中,我们发现右肾多支肾动脉伴复杂极动脉1例,报告如下。老年男尸,身长180cm。解剖腹膜后间隙时发现平第2腰椎体高处,于肠系膜上动脉起点下方约1cm 处,自腹主动脉两侧壁发出左、右肾动脉。左肾动脉无异常。右肾动脉外径8mm,经下腔静脉后方     

胫后动脉内踝上皮支皮瓣的供血特点及意义

目的：通过对胫后动脉内踝上皮支血管铸型标本的观测,探讨胫后动脉内踝上皮支皮瓣移植修复腿足部皮肤软组织缺损的手术设计,阐明胫后动脉内踝上皮支的血供分区及特点,为其临床应用提供解剖学依据。方法：对20侧新鲜成人小腿标本利用血管铸型后行分层碱腐蚀,用游标卡尺和坐标纸法获取各项数据,对胫后动脉内踝上穿支的浅出点、分支、分布、吻合及供血区的形状和面积进行分析。结果：胫后动脉内踝上皮支的浅出点在髁踝连线上投影距离90％集中于8～12 cm,平均血管直径为（0.96±0.24）mm;解剖供血区近似椭圆形,面积为（72±8）cm²,占小腿面积的14.22%;以胫后动脉内踝上皮支的浅出点为坐标原点,浅出点至内踝后缘与跟腱中点的连线为坐标系的纵轴,经原点向纵轴作一垂线为坐标系的横轴,将内踝上皮支的的供血区分成4个象限,胫后动脉内踝上皮支各个象限的供血面积：内上象限（15±2）cm²,外上象限 （8±3 ）cm²,内下象限（25±4）cm²,外下象限（24±3） cm²;胫后动脉内踝上皮支的二级分支和三级分支在内上、外下2个象限分布较多,计算其轴向性（Dmax/L）为1.47±0.31;该皮支与周围血管吻合非常丰富,并参与隐神经营养血管链的构成,其动力供血区面积可达小腿内侧面下2/3。结论：胫后动脉内踝上皮支的浅出点相对恒定,其供血区域大,且易于切取和转位,可依据其分支、分布和吻合情况,以胫后动脉内踝上皮支作供血动脉进行双轴点皮瓣和双轴皮瓣的手术设计,修复腿足部皮肤软组织缺损。     

胆囊动脉并肾动脉变异一例

胆囊动脉、肾动脉变异均有统计报道 ,但胆囊动脉且两肾多支动脉伴副肾动脉变异未见文献报道 ,为积累资料和提供临床参考 ,现报告如下。1　标本介绍成年男尸 ,解剖腹部发现有下列动脉变异。1 .1　胆囊动脉肝、胆囊位置、外形和腹腔干均未见异常。肝固有动脉左支上升 5.0 mm后发出肝中动脉 (外径为 1 .5mm) ,右支 (外径为 2 .5mm)起点偏右 1 .0 mm处由前壁发出胆囊动脉 (外径1 .5mm)。胆囊动脉发出后前行 2 .0 mm渐向右弯曲 ,横行于肝总管前方入 Calot三角 ,在胆囊管上缘处至胆囊颈部 (详见图1 )。图 1　胆囊动脉1 .2　多支肾动脉、副肾动脉…     

肾副动脉异常一例

男尸,约30岁,左肾有一支肾副动脉,发自左睾丸动脉的起点下方约30ｍｍ处,该肾副动脉的外径2.1ｍｍ,由左肾脏的右下方斜向左上方,走行于肾静脉与肾动脉之间,继而进入左肾上端,以上、下两支入肾实质,上、下两支的外径分别为1.8ｍｍ、1.5ｍｍ。讨论　肾副动脉往往是起始及行程有变异的肾段动脉,常由肾动脉、腹主动脉、膈下动脉发出。而此例肾副动脉则由睾丸动脉发出较为罕见。提示在临床肾脏手术中应注意勿伤及肾副动脉,以免发生大出血。同时也不宜随便结扎此动脉,以免引起肾脏的局部缺血坏死。肾副动脉异常一例@付敏!解剖学教研室,赣州341000…     

组织瓣移植修复小腿毁损时供区血管蒂的应用研究

目的：取旋股外侧动脉降支血管逆行转位供血,与组织瓣移植吻合一次性修复小腿毁损伤.方法：取30例动脉内灌注红色乳胶的成人下肢标本（男女各15例）,以髂前上嵴、髌骨上缘为标志解剖观测（D旋股外侧动脉降支血管的走行、分支、分布与起始处外径;②血管外径在0.Smm和0.5mm时分别与起始处、髌骨下缘的距离;③旋眨动脉降支与膝周围动脉的吻合关系.结果：降支血管起始处的外径为（2.73±0.35）mm,外径为0.8mm时与起始处、髌骨下缘的距离分别为（21.55±1.23）cm、（9.09±1.09）cm;外径为0.5mm时与起始处、髌骨下缘的距离分别为（24.56±0.92）cm、（6.09±0.86）cm;旋股外侧动脉降支在下行过程中发出多支肌支、肌皮支和皮支,终支与膝上外侧动脉在骨膜处、深筋膜层和浅筋膜层均有广泛的吻合.结论：在小腿大面积毁损、创面无可供吻合的血管时,可取旋股外侧动脉降支血管逆行转位供血,与组织瓣移植吻合进行一次性修复.     

Anomalies of the renal, phrenic, suprarenal arteries

This is a case where multiple anomalies of the posterior abdominal wall arteries were found in a single male cadaver aged 50-years. These anomalies were accessory renal, a pre-hilar division of the renal, unilateral origin of the inferior phrenic artery from the renal and aberrant suprarenal arteries. The accessory renal and the pre-hilar branch of the renal resembled polar arteries that supplied both poles of the right and the lower pole of the left kidney. The accessory renal and the pre-hilar branch, or their branches crossed in front of the hilar of the kidneys close to the ureteropelvic junction to reach the lower poles of the kidneys.     

Anomalies of the renal, phrenic and suprarenal arteries: case report

This is a case where multiple anomalies of the posterior abdominal wall arteries were found. These were accessory renal, a pre-hilar division of the renal, a unilateral origin of the inferior phrenic artery from the renal and aberrant suprarenal arteries. The accessory renal and the pre-hilar branch of the renal resembled polar arteries that supplied the upper and lower poles and similar segments of both kidneys.     

经皮肾动脉交感神经消融术对难治性高血压患者术后即刻肾动脉直径的影响

目的 探索经皮肾动脉交感神经消融术(RDN)对难治性高血压患者术后即刻肾动脉直径的影响。 方法 入选难治性高血压患者,所有患者在术前、术后即刻使用定量冠状动脉造影技术(QCA)进行肾动脉直径的测量并记录数值,术中记录阻抗起始值、阻抗最低值、消融点位、消融功率等消融参数指标。所有患者于RDN术前、术后6个月检测动态血压。 结果 共12例符合标准的难治性高血压患者入选了本研究,平均入院动态血压为(185±15)/(99±9)mmHg (1 mmHg=0.133 kPa)。在RDN术后6个月,动态血压平均值下降31/15 mmHg,与术前相比差异有统计学意义(P <0.001)。所有患者的肾动脉直径在消融术后即刻均出现扩张,肾动脉直径平均值增加0.6 mm,与术前相比差异有统计学意义(P <0.001)。消融阻抗下降值与肾动脉术后即刻直径相关(r=0.74,P=0.006),但患者术后肾动脉直径扩张程度并不能预测术后血压的变化(P >0.05)。所有患者均未发生任何外周血管并发症。 结论 RDN术可降低难治性高血压患者的动态血压水平,并可在术后即刻扩张肾动脉直径,肾动脉直径的扩张程度和消融阻抗的下降值正相关,但肾动脉直径的扩张程度无法预测患者的远期血压水平。     

Effects of renal artery stenting on renal function and blood pressure in patients with atherosclerotic renovascular disease

Objective To study the effects of percutaneous renal artery intervention on renal function and blood pressure in patients with renal artery stenosis. Methods Eighty-seven patients with severe uni- or bi-lateral renal artery stenosis (luminal diameter narrowing ≥70%) and clinical hypertension received renal artery stenting between January 2002 and December 2002. The changes in blood pressure and serum creatinine level and creatinine clearance (CCr) 48 hours after intervention and during 6 months of follow-up were assessed.Results Renal stenting was performed in 98 stenotic arteries of 87 patients, and the procedural success rate was 100%. Serum creatinine level was slightly elevated from (176±21) μmol/L to (179±11) μmol/L (P=0.15) 48 hours after the procedure, but significantly decreased to (149±15) μmol/L at 6 months (P&lt;0.001). CCr was also greatly improved ［(37±11) ml/min before versus (51±8) ml/min at 6 months, P&lt;0.001］. During follow-up, 61% of the patients experienced a normal renal function. Despite conventional medical treatment, systolic and diastolic blood pressures were also significantly decreased after stenting ［(163±23)/(96±13) mm Hg before versus (148±12)/(79±15) mm Hg at 6 months, all P&lt;0.001］, and hypertension was well controlled in 67% of the patients at 6 months’ follow-up.Conclusion Renal artery stenting has a high success rate and is effective in improving renal function and blood pressure for patients with severe renal artery stenosis.     

Dual-energy computed tomography angiography for evaluating the renal vascular variants

Background  Recognizing renal vascular variants preoperatively is important in order to avoid vascular complications during surgery. This study aimed to investigate the renal vascular variants with dual-energy computed tomography (DECT) angiography to provide valuable information for surgery.

Methods  A total of 378 patients underwent DECT. The number, size, course and relationships of the renal vessels were retrospectively observed from the scans. Anomalies of renal arteries and veins were recorded and classified. Multiplanar reformations (MPR), maximum intensity projections (MIP), and volume renderings (VR) were used for analysis.

Results  In 378 patients (756 kidneys), renal artery variations were discovered and recorded in 123 kidneys (16.3%, 123/756) of 106 patients (28.0%, 106/378). Type IB (early branches of the only one main renal artery) and IC (accessory renal artery with only one main renal artery) were found most frequently with an incidence of 11.4% (43/378) and 14.5% (55/378). The incidence of renal artery variations in the left kidney was not statistically different than in the right kidney (12.4% vs. 11.1%). The incidence of renal vein variations was detected in 104 patients (27.5%, 104/378). The incidence of venous variants in the right kidney was higher than in the left kidney (20.1% vs. 7.4%), but left renal vein variations were more complex. Variants of the left renal vein were detected in 28 patients including type 1 (circumaortic left renal vein) in eight cases, type 2 (retroaortic left renal vein) in seven cases, type 3 (abnormal reflux) in six cases, type 4 (late venous confluence of left renal vein) in five cases, and type 5 (rare type) in two cases. The frequency of left renal vein variation associated with the left renal accessory artery was significantly higher than with early branches of the left renal artery (P=0.037).

Conclusions  The renal vascular variants are rather common and complex. DECT angiography can demonstrate the precise anatomy of the renal vessels, which is a benefit for renal transplantation or other renal operations

     

双源CT血管造影对活体肾移植供体术前的综合评价

目的评价双源CT血管造影在活体肾供体术前综合评价中的价值。方法收集28例活体肾供体术前的双源CT血管造影及血管三维成像资料,并与手术结果进行对照分析。结果 28例双源CT血管造影横断面CT及MPR显示双肾大小、形态位置、肾实质密度均正常。VR、MIP显示双肾动脉粗细、形态亦正常;12例VR及MIP也较好显示了双侧肾小盏、肾盂及输尿管上段。其中共计显示了58支肾动脉,包括左肾副动脉2例;57支肾静脉,包括1例左双肾静脉;29支肾盂输尿管,包括1例右侧双肾盂双输尿管。28例活体供体手术结果与双源CT影像所见完全吻合,准确率为100%。结论双源CT血管造影作为术前活体肾供体的有效筛查技术,具有重要的临床应用价值。     

64层螺旋CT血管成像副肾动脉分析

目的 运用64层螺旋CT血管成像技术(computed tomography angiography,CTA)研究副肾动脉(accessory renal artery,ARA)解剖,并讨论其显示ARA的能力.方法 64层螺旋CT行135例肾动脉CTA,数据传至工作站重建并详细记录每侧副肾动脉情况.采用SAS 9.1.3软件统计分析.结果 56例(41.5%)患者发现ARA70支(20.9%).1支型43例(76.7%);2支型12例(21.4%);3支型1例(1.9%).左侧47支(67.1%),右侧23支(32.9%).腹主动脉起源者50支(71.5%);早发分支20支(28.5%).肾上端入肾者32支(45.7%);肾下端入肾者25支(35.7%);肾门周围入肾者13例(18.6%).结论 64层螺旋CTA能够较好显示ARA,为血管造影术以及外科手术提供更多解剖学信息.     

ApoE-/-小鼠肾动脉狭窄及肾损害特点观察

目的 建立动脉粥样硬化性肾动脉狭窄(atherosclerotic renal artery stenosis, ARAS)小鼠动物模型,并观察其肾损害特点.方法 取载脂蛋白E基因缺陷(ApoE-/-)小鼠(25～51周龄)的肾动脉和肾脏,动态观察肾动脉病变进展各阶段相应的肾脏病变.根据ARAS程度分3组(A组:＜50%;B组:50%～70%;C组:＞70%).A组又根据斑块是否破裂分为A1(未破裂)和A2(破裂)亚组.结果 建立了ARAS小鼠动物模型.肾动脉和肾脏的变化是:① A1组未发现其下游肾脏病理改变;②A2组其下游肾内肾小管周围毛细血管减少,肾小管上皮细胞肿胀,电镜下可见细胞内线粒体肿胀;③B组和C组已发生斑块破裂,其肾内肾小管周围毛细血管减少明显,与A2组比较,差异显著(P＜0.01);肾小管上皮细胞肿胀、脱落、坏死;肾小管间质病变严重.结论 ApoE-/-小鼠建立的ARAS模型易行、稳定、重复性好.