摘要
目的探讨CT血管成像（CTA）技术对肾血管解剖形态的评估，以及在腹腔镜下肾肿瘤保留肾单位手术（LNSS）中对肾动脉的控制指导价值。方法肾肿瘤患者87例，均行LNSS。CTA组40例，术前行CTA检查，采用容积再现（VR）、最大密度投影（MIP）等重建技术评估肾动脉血管解剖形态；未行CTA检查47例作为对照组。比较2组手术时间，术中热缺血时间、出血量、中转开放手术率，住院时间，术后并发症发生率及疗效。结果CTA组和对照组手术时间分别为94（76～118）和115（90～190）min，术中热缺血时间分别为23（12-39）和29（18-40）min，2组间比较差异均有统计学意义（P〈0．05）；术中出血量分别为90（20～160）和130（90～600）ml，2组间比较差异有统计学意义（P〈0．01）；中转开放手术分别为0例和1例，中转原因为术中分离肾动脉时出血严重，影响视野；术后住院时间分别为4．1（3～5）和5．5（3～9）d，2组间比较差异均有统计学意义（P〈0．05）。2组肾癌患者病理检查切缘均为阴性。术后随访4～32个月，平均16个月，2组患者均无肾功能损害和肿瘤复发或转移，2组各有1例尿瘘。结论CTA作为LNSS术前了解肾动脉的有效方法，能指导操作者术中更快速、准确地处理肾动脉，缩短手术时间和热缺血时间，减少术中出血量及术后并发症的发生，同时并不增加患者经济负担。
Objective To discuss the application value of CT angiography （CTA） in evaluating renal artery anatomy of laparoscopic nephron-sparing surgery （LNSS） before operation. Methods Retroperitoneal LNSS was performed in 87 patients with renal tumors. Forty cases underwent CTA before LNSS, volume rendering and maximum intensity projection of renal artery were used as three- dimensional reconstruction. The other 47 without CTA were compared as control. Treatment outcomes of the 2 groups were compared, including operation time, warm ischemia time, blood loss, conversion to open surgery, hospitalization stay after operation, and complications after operation. Resuits All the procedures were completed laparoscopically with no conversion to open surgery in CTA group. One patient underwent conversion to open surgery in the control group. In CTA and control group, the operation time was 94 min（range, 76--118）and 115 rain（90--190, P〈0.05）. The warm ischemia time was 23 min（12--39）and 29 min（18--40, P〈0.05）. Blood loss was 90 mi（20--160） and 130 m1（90--600, P〈0.01）. Hospitalization stay after operation was 4.1 d（3--5） and 5.5 d（3-- 9）, respectively（P〈0.05）. The pathologic examination showed negative surgical margin in all cases of renal cell carcinoma. The patients were followed up for 4 months to 32 months. Neither distant nor local recurrences were observed, and the renal function was normal in all cases. Urinary leakage occurred in 1 patient of each group. Conclusions CTA could be an effective method in evaluating the supply blood vessels of kidney before LNSS. And it can shorten the operation time and warm ischemia time, reduce the blood loss, as the result of helping the operaters deal with renal artery more quickly and accurately.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2009年第5期309-312,共4页
Chinese Journal of Urology
关键词
肾肿瘤
腹腔镜
保留肾单位手术
体层摄影术
X线计算机
重建
Kidney neoplasms
Laparoscopes
Nephron-sparing surgery
Tomography, X-ray computed
Reconstruction
