螺旋CT三维成像技术在后腹腔镜下保留肾单位手术前的应用价值

Application of preoperative three dimensional helical CT assessment in retroperitoneai iaparoscopic nephron-sparing surgery

目的探讨多层螺旋CT三维重建技术选择适合后腹腔镜下保留肾单位手术（NSS）患者的临床应用价值。方法26例。肾肿瘤患者术前行螺旋CT动态增强扫描，利用三维重建技术构建肾脏图像，测量肿瘤大小及其与集合系统的距离，评估肾肿瘤与肿瘤供应血管及集合系统之间的关系。结果26例重建肾脏三维图像均能清楚显示肾肿瘤、供瘤血管和集合系统之间的关系。肿瘤直径（2．9±1．1）cm，肿瘤与集合系统之间距离（1．2±0．1）cm，2例间距〈1．0cm者改用开放性NSS。24例顺利完成后腹腔镜下NSS，术后无继发性大出血及漏尿发生。结论螺旋CT三维成像技术能清晰重建肾脏解剖构像，为选择后腹腔镜下NSS治疗肾肿瘤提供可靠依据。

Objective To evaluate the role of preoperative three dimensional helical CT assessment in retroperitoneal laparoscopic nephron-sparing surgery （NSS） for patients with renal tumor. Methods Twenty-six patients with small renal tumors underwent dynamic CT scan before retroperitoneal laparoscopic NSS. Multiplanar reformation, volume-rendered and maximum intensity projection images were created for measuring the tumor size and the distance between the tumors and collecting system. The relationship of the renal tumor, its vasculature and renal collecting system was assessed. Results The relationship of the tumor, renal collecting system and tumor vessels was well shown on the three dimensional helical CT images created from volume-rendered and maximum intensity projection images. The mean tumor size of 26 cases was （2. 9± 1. 1）cm. The mean distance between the tumor and collecting system was （1.2±0.1）cm. There were 2 cases converted to open NSS due to the short distance between tumor and collecting system （less than 1.0 cm）. The other 24 cases were sue cessfully performed without post-operative hemorrhage and urine leakage. Conclusions The three dimensional helical CT scan provides better understanding of the kidney anatomy and surrounding structures. It is helpful in decision making of retroperitoneal laparoscopie NSS.