肾癌患侧肾动脉变异及其对根治性肾切除术影响的MDCTA评价

目的:采用MDCTA技术观察肾癌患者患侧肾动脉变异并评价其对根治性肾切除术操作的影响。方法:对109例临床诊断为肾癌的患者术前行CT三期增强扫描,并对动脉期CTA图像进行后处理,观察并记录肾癌患侧变异肾动脉的发生并及可能影响根治性肾切除术的肾动脉因素。结果:肾癌患侧变异肾动脉的发生率为11.9%(13/109),表现为多支肾动脉84.6%(11/13)和过早分支23.1%(3/13),含混合型1例;副肾下极动脉最常见(71.4%),且其开口位置和走行变异较大,其中右侧副肾下极动脉开口位于主肾动脉下为(29.44±15.13)mm,约50%走行于下腔静脉前,50%走行于下腔静脉后;左侧副肾下极动脉开口位于主肾动脉下方(42.55±0.64)mm。结论:CT多期增强扫描动脉期CTA图像可以充分显示肾癌患侧肾动脉变异情况,术前明确变异血管的存在及走行对根治性肾切除术的操作有重要意义。

Study on renal artery variations in the affected side of renal carcinoma with MDCTA and the influence on radical nephrectomy

Objective：To study the renal artery vaariations in the affected side of renal carcinoma with MDCTA and the influence on radical nephrectomy.Methods：MDCT enhanced scanning was performed in 109 patients diagnosed clinically as renal cell carcinoma.The variations of renal artery in affected side of renal carcinoma were observed and recorded on post-processing images,and correlative study with surgery was performed.Results：Variations of renal artery of the affected side was found in 13 patients（11.9%,13/109）.There were 11（84.6%） cases with multiple renal arteries,three cases（23.1%） with early branching,including one case with mixed variation.The accessory renal inferior pole artery was the most common type of variation（71.4%）,and the origin and course varied.The origin of right inferior pole arteries were（29.44±15.13）mm below the major renal arteries.Half of them were in front of the IVC and other half behind it.The origin of left inferior pole artery was（42.55±0.64）mm below the major renal artery.Conclusion：MDCTA can precisely show variations of renal artery in affected side of renal caarcinoma.The preoperative demonstration of such variations can be helpful to choose adequaate procedures for surgical operation.