64层螺旋CTA对肾动脉变异及左肾静脉解剖的研究

A Study of The Variation of Renal Artery and The Anatomy of Left Renal Vein with 64-slice Spiral CT

目的评价64层螺旋CT血管成像(CTA)对观察肾动脉变异及左肾静脉(LRV)解剖的价值。资料与方法回顾性分析105名正常人的64层螺旋CT肾血管影像资料,观察肾动脉变异及LRV解剖,测量肠系膜上动脉(SMA)与腹主动脉(AA)之间的夹角(α)、SMA与AA夹角间隙内LRV中心水平SMA的后缘与AA前缘之间的距离(D1)、SMA与AA夹角间隙内十二指肠中心水平SMA的后缘与AA前缘之间的距离(D2)、SMA与AA夹角间隙内LRV中心与SMA起始根部中心的距离(D3)、SMA与AA夹角间隙内十二指肠中心与SMA起始根部中心的距离(D4),同时测量LRV通过α角时的内径(a),近左肾侧最大内径(b),计算b/a值,并进行统计学分析。结果105名正常人共210只肾脏,肾动脉变异分别占病例数和肾脏数的32.4%(34/105)和17.6%(37/210),其中Ⅰ类(肾门前肾动脉分支)13只肾脏,Ⅱ类(肾副动脉)24只肾脏。α、D1、D2、D3、D4、a、b、b/a的均值分别为(51.2±18.5)°、(13.4±6.0)mm、(17.0±7.2)mm、(20.3±5.0)mm、(56.9±12.5)mm、(5.8±2.0)mm、(10.5±2.3)mm、(2.0±0.9),α角与D1、D2、a存在正相关,α角与D3、D4、b/a之间存在负相关,α角与b不存在相关性。结论64层螺旋CTA可清晰显示肾动脉变异、LRV和十二指肠的解剖关系,并准确测量SMA与AA之间的夹角,对指导肾脏手术及诊断胡桃夹综合征(nutcracker syndrome,NCS)和十二指肠淤积症有重要的临床价值。

Objective To evaluate the value of 64-slice spiral CT angiography （CTA） in finding the variation of renal artery and the anatomy of left renal vein （LRV）. Materials and Methods 64 slice spiral CT angiography of 105 subjects with nomal kidneys were retrospectively reviewed to observe the variation of renal artery and the anatomy of LRV. The angle （or） between superior mesenteric artery （SMA） and abdominal aorta （AA）, the distance between SMA and AA at the level of LRV （D1） and duodenum （D2） in the angle, the distance between LRV in the angle and the origin of SMA （D3）, the distance between duodenum in the angle and the origin of SMA （ D4）, the diameter of LRV through the angle （ a）, the largest diameter of LRV near the left renal （b） and the ratio of b/a were calculated. Results In 105 normal person with 210 kidneys, the rate of the variation of renal artery was 32.4% per person and 17.6% per kidney. The variation of renal artery included category I in 13 kidneys and category II in 24 kidneys. The mean of α,D1 ,D2 ,D3 ,D4 ,a,b,b/a was （51.2 ±18.5） ^o,（13.4±6.0） mm,（17.0±7.2） mm,（20.3±5.0） mm,（56.9 ±12.5） mm,（5.8 ±2.0） mm,（10.5 ± 2.3 ） mm, （2.0 ± 0.9 ）. The correlations between α and D1, D2, a were positive, The correlations between α and D3, D4, b/a were negative. There was no correlation between α and b. Conclusion 64 slice spiral CT angiography can show the variation of renal artery and the adjoining anatomy of LRV and duodenum clearly. The angle between SMA and AA can be measured accurately on CT angiography images. 64 slice spiral CT angiography has significant clinical vaule in the guidance for the renal surgery and the diagnosis of nutcracker syndrome and duodenum stasis syndrome.