螺旋CT三维血管成像在重复肾切除术中的应用

CLINICAL APPLIANCE OF COMPUTER TOMOGRAPHY ANGIOGRAPHY WITH THREE DIMENSIONAL RECONSTRUCTION IN HEMINEPHRECTOMY OF DUPLEX KIDNEY

目的探讨螺旋CT三维血管成像在重复肾切除术中的对肾血管处理的应用价值。方法采用多层螺旋CT对2007年4月—2010年2月期间12例重复肾患者术前进行螺旋CT三维血管成像,对所得图像分别用最大密度投影、多平面重组及容积再现等三维成像技术进行分析,指导术中对肾血管的处理。结果术前经螺旋CT扫描获得的上下位肾血管的解剖及变异血管与术中探查相吻合,手术均获成功,术后随访3～18个月,无出血及漏尿等并发症,下半肾功能良好。结论螺旋CT三维血管成像作为一种无创的、有效的血管成像技术,术前能全方位清晰地显示上下位肾血管的解剖结构及变异血管,在重复肾切除术中对肾血管的处理有重要的指导作用,能有效减少术中术后并发症。

Objective To explore the clinical value of spiral computed tomography angiography （CTA） with three - dimensional （3 D） reconstruction for handling the kidney vessels of upper pole in partial nephrectomy for duplex kidney. Methods From April 2007 to February 2010,12 patients with duplex kidney underwent 3D reconstruction using CTA technique; the images were analyzed using 3D reconstruction techniques, including maximum intensity projection （MIP）, multiplanar reformation （MPR）, and volume rendering （VR）, which were used to direct in the treatment of renal vessels in heminephrectomy. Results The anatomical structure of kidney vessels and the vascular abnormalities acquired by preoperative CTA was consistent with intraoperative exploration and all operations were performed successfully. During 3 - 18 months follow up, no complications such as bleeding and leakage occurred and the function of the lower pole was good in all patients. Conclusion CTA with 3D reconstruction as a noninvasive, effective vascular imaging technology can exhaustively and three - dimensionally display the vascular anatomy and abnormality of the upper and lower kidney pole, it plays an important guiding role in handling renal vessels in heminephrectomy, and can effectively reduce the intraoperative and postoperative complications.