CT肾血管成像在后腹腔镜肾部分切除术中的应用

Clinical value of renal vascular CT angiography in retroperitoneal laparoscopic partial nephrectomy

摘要:

目的：探讨肾CT血管成像（computed tomography angiography，CTA）在后腹腔镜肾部分切除术中的临床意义。方法：本研究选择需要行后腹腔镜肾部分切除患者40例，随机分为2组，20例术前行肾血管CTA，20例仅作一般增强CT。了解肾动脉变异情况，比较２组患者手术时间、热缺血时间、术中出血量、术后住院时间、术后肾小球滤过率（glomerular filtration rate，GFR）降低值、并发症发生率。结果：CTA组术前发现肾动脉分布情况与术中解剖情况一致。CTA组1例改行腹腔镜根治性肾切除术，对照组2例改行开放根治性肾切除术。CTA组中有7例在术中选择性阻断肾动脉。２组均无明显并发症发生；２组术后病检均未见切缘阳性。CTA组和对照组热缺血时间分别为（27.4±6.2） min和（29.2±5.1） min，差异无统计学意义（t=1.00，P=0.322）；CTA组术中出血量、术后住院时间、术后GFR降低值分别为（33.3±11.0） ml、（4.2±0.8） d、（6.1±2.1） ml/min明显低于对照组，差异有统计学意义（t=4.04、P=0.001，t=2.85、P=0.007，t=3.06、 P=0.004）。结论：CTA能为后腹腔镜下肾部分切除术提供有效指导，可以成为术前常规检查。

Abstract:

Objective：To evaluate the clinical application value of renal vascular computed tomography angiography（CTA） during retroperitoneal laparoscopic partial nephrectomy. Methods：Totally 40 patients needing for retroperitoneal laparoscopic partial nephrec－tomy were divided into two groups randomly. The variations of renal artery were investigated via CTA and the perioperative surgical outcomes were analyzed between the two groups，including operative time，warm ischemia time，blood loss，postoperative hospital stay，GFR reduction，and the incidence of complications. Results：Renal artery distribution of CTA was consistent with the intraoperative anatomical situation. One case in CTA group was diverted into laparoscopic radical nephrectomy，two cases in control group were con－verted to open radical nephrectomy and seven cases in CTA group accepted the selective blocking of renal artery surgery. No signif－icant complication and positive margin was found. The warm ischemia time of CTA group and control group was （27.4 ± 6.2） min and （29.2±5.1） min（t=1.00，P=0.322），without statistical differences（t=1.00，P=0.322）. Blood loss（33.3 ± 11.0） ml，postoperative hospital stay（4.2 ± 0.8） d and GFR reduction （6.1±2.1） ml/min of CTA group were significantly lower than those of control group（t=4.04，P=0.001；t=2.85，P=0.007；t=3.06，P=0.004）. Conclusion：CTA can provide effective guidance for retroperitoneal laparoscopic partial nephrectomy and should become a routine preoperative examination.