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目的探讨MSCT增强联合CT血管成像(CTA)技术在腹腔镜下肾肿瘤切除术中的临床应用价值。方法回顾性分析29例经腹腔镜切除的肾肿瘤患者术前行MSCT联合CTA检查资料,采用多平面重组(MPR)、最大密度投影(MIP)、容积再现(VR)等计算机重建技术按照PADUA评分系统评估肾脏肿瘤的位置、血供、肿瘤与集合系统的关系以及肾脏血管系统,分析肾肿瘤解剖结构与腹腔镜下肾肿瘤切除术式之间的关系。结果按照PADUA评分系统显示,肿瘤的纵向位置位于上/下极20例,中部9例;肿瘤位于肾脏外侧缘23例,内侧缘6例;肿瘤外凸率≥50%14例,<50%12例,完全内陷3例;与肾窦有关9例,与肾窦无关20例;与集合系统有关20例,与集合系统无关9例;肿瘤最大径≤4 cm 11例,4.1~7 cm 10例,>7 cm 8例。结果行后腹腔镜肾根治切除术(LRN)18例,评分显示≥9分;行后腹腔镜下肾部分切除术(LPN)11例,评分显示为≤8分。同时发现双支肾动脉5例,肾动脉走行变异1例;肾静脉瘤栓形成1例,淋巴结转移2例,1例肾静脉胡桃夹征。结论 MSCT增强检查特别是肾动脉CTA能够清晰显示肾血管的起源、走行、变异及发现副肾动脉,清楚显示肿瘤与肾脏血管系统、集合系统的关系以及肿瘤的载瘤动脉,对腹腔镜下肾肿瘤切除术式的选择以及减少术后并发症具有重要的临床指导价值。
Objective To investigate the clinical value of MSCT enhanced CT angiography (CTA) in laparoscopic nephrectomy. Methods The data of MSCT and CTA in 29 patients undergone laparoscopic resection of renal tumor were analyzed retrospectively. According to the PADUA score (MAD), maximum volume projection (MIP) and volumetric reconstruction (VR) Systemic assessment of renal tumor location, blood supply, tumor and collection system and renal vascular system, analysis of renal tumor anatomy and laparoscopic nephrectomy relationship. Results According to the PADUA scoring system, the tumor was longitudinally located in 20 cases in the upper / lower pole and 9 in the middle. The tumor was located in the lateral margin of the kidney in 23 cases and the medial margin in 6 cases. The tumor protruding rate was ≥50% in 14 cases, <50% Cases were completely invaginated in 3 cases, 9 cases were related to the renal sinus, 20 cases were unrelated to the renal sinus, 20 cases were related to the collecting system and 9 cases were not related to the collecting system. The maximum diameter of the tumor was less than 4 cm in 11 cases and 4.1 ~ 7 cm 10 Cases,> 7 cm 8 cases. Results After the laparoscopic radical nephrectomy (LRN) in 18 cases, the score showed ≥9 points. The patients underwent laparoscopic partial nephrectomy (LPN) in 11 cases, the score was ≤8 points. Also found in 5 cases of double renal artery, renal artery walking variation in 1 case; renal vein tumor thrombus in 1 case, 2 cases of lymph node metastasis, 1 case of renal vein walnut clamp sign. Conclusion MSCT enhanced examination, especially renal artery CTA, can clearly show the origin, course and variation of renal vessels, find the accessory renal artery, clearly show the relationship between tumor and renal vascular system and collecting system, and the tumor-bearing artery. The choice of tumor resection and the reduction of postoperative complications have important clinical value.