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目的探讨利用多排CT成像技术对肾癌伴有先天性微小肾动静脉畸形(r AVM)患者的诊断价值,为肾癌根治术的实施提供可靠依据。方法 82例需实施肾癌根治术的患者行双侧肾64排CT肾血管成像检查并采用r AVM诊断的金标准数字减影血管造影(DSA)进行证实,DSA证实肾癌伴有r AVM作为观察组,肾癌不伴有r AVM作为对照组。对两组CT成像图像质量分级进行比较;计算CT成像检查的灵敏度、特异度、阳性似然比、阴性似然比、诊断指数、Youden指数,比较两种检查方式对82例患者肾微血管病变发现率;两组患者的手术情况及术后情况比较。结果经过DSA检查将肾癌伴有r AVM患者34例作为观察组,肾癌不伴有r AVM患者48例作为对照组,两组图像质量分级比较差异无统计学意义(P>0.05)。DSA微血管畸形、肾静脉癌栓、腔静脉癌栓的发现率分别为41.46%、17.07%、10.98%,均高于CT成像的37.80%、12.20%、6.10%,但比较差异无统计学意义(P>0.05)。采用CT成像检查肾癌伴有r AVM的灵敏度为79.41%、特异度为91.67%、阳性似然比为9.529、阴性似然比为0.225、诊断指数为1.71>1.70、Youden指数为0.71。两组患者手术时间、术中出血量、术后下床活动时间、术后出院时间比较差异均无统计学意义(P>0.05)。结论多排CT成像技术对肾癌伴有r AVM患者的血管解剖结构能够进行明确诊断,在手术中有目的的游离肾脏、避免盲目分离造成血管损伤。
Objective To explore the diagnostic value of multislice CT imaging in patients with renal cell carcinoma accompanied with congenital small renal arteriovenous malformation (rVAVM), and to provide a reliable basis for the implementation of radical nephrectomy. Methods Eighty-two patients undergoing radical nephrectomy were examined by bilateral renal 64-slice CT renal angiography and confirmed by gold standard digital subtraction angiography (DSA) with r AVM. DSA confirmed that renal cancer was associated with r AVM Observation group, renal cell carcinoma without r AVM as a control group. To compare the grading of CT imaging quality of the two groups; to calculate the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic index, Youden index of CT imaging examination, 82 cases of renal microvascular lesions were found Rate; two groups of patients with surgery and postoperative conditions. Results 34 patients with renal cell carcinoma accompanied with r AVM and 48 patients with renal cell carcinoma without r AVM had DSA. There was no significant difference in image quality between the two groups (P> 0.05). The detection rates of DSA microvasculature, renal vein thrombosis and vena cava tumor thrombus were 41.46%, 17.07% and 10.98%, respectively, which were all higher than 37.80%, 12.20% and 6.10% of CT images, but the difference was not statistically significant P> 0.05). The sensitivity and specificity of CT imaging in detecting renal cancer with r AVM were 79.41%, 91.67%, 9.529, 0.225, respectively. The diagnostic index was 1.71> 1.70, and the Youden index was 0.71. There was no significant difference in operation time, blood loss, postoperative ambulation time and postoperative discharge time between the two groups (P> 0.05). Conclusions Multislice CT imaging can diagnose the vascular anatomy of patients with renal cell carcinoma complicated with r AVM clearly. In the surgery, there is a purpose of free kidney, avoiding the blind separation of vascular injury.