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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80 ml,手术平均时间170 min,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。
Objective: To explore the guiding significance of preoperative multi-slice spiral CT angiography in retroperitoneoscopic nephrectomy. Methods: Forty-five patients underwent preoperative 64-slice spiral CT angiography. The three-dimensional anatomic relationship between renal vessels and diseased kidneys and lesions was clarified. Under the guidance of them, radical nephrectomy was performed in 14 cases and partial nephrectomy in 7 cases Among them, 2 cases were partial nephrectomy with segmental renal artery occlusion, 7 cases with renal ureteric sleeve sleeve resection, 16 cases with simple nephrectomy and 1 case with upper nephron excision. Results: Multi-slice CT angiography showed 26.7% of arterial anatomy, 6.7% of arterial lesions, 22.4% of vein anatomical abnormalities, and the suggested vascular anomalies and lesions showed 100% coincidence with intraoperative findings Abnormal kidney tumor venous blood vessels were found, failing to clearly show 6.7% in spiral CT angiography. Under the guidance of multi-slice spiral CT angiography, intraoperative renal disease was treated quickly and accurately and the operation was successful. Intraoperative bleeding average 80 ml, the average operation time 170 min, no transit open surgery. Conclusion: Preoperative multi-slice spiral CT angiography can directly and accurately evaluate the three-dimensional anatomic relationships between blood vessels, especially arterial vessels and diseased kidneys and lesions, to understand the possible anatomical variations of arteriovenous or vascular diseases, to develop surgical plans, Guide those who quickly and accurately handle the blood vessels, to avoid blind operation, reduce bleeding and complications. In retroperitoneoscopic nephrectomy, there is a more important value.