多层螺旋CT血管成像在后腹腔镜肾蒂淋巴管结扎术中的应用

Multi-slice spiral CT angiography for retroperitoneoscopic renal pedicle lymphatic disconnection

目的:评价多层螺旋CT血管成像(MSCTA)在后腹腔镜肾蒂淋巴管结扎术中的应用。方法:对3例术前超声诊断肾血管变异和2例未进行血管超声检查的乳糜尿患者,在后腹腔镜肾蒂淋巴管结扎术前行MSCTA肾血管扫描,比较MSCTA发现和术中所见,评价MSCTA检查对手术的指导意义。结果:5例MSCTA显示的血管数目、走行完全与术中所见一致。在MSCTA的指引下,2例患者肾脏的正常血管和3例患者的主要血管、变异血管被快速定位,血管周围淋巴管被顺利结扎。5例患者均顺利进行后腹腔镜手术治疗,无肾血管损伤。无血管畸形患者平均手术时间(67.5±17.7)min,肾血管畸形患者平均手术时间(91.7±22.5)min。术后乳糜尿消失。结论:MSCTA对后腹腔镜肾蒂淋巴管结扎术有重要的指导意义,特别是在肾血管存在变异的患者。

Objective：To evaluate the role of multi-slice spiral computed tomography angiography （MSCTA） inthe preoperative evaluation of renal vessels and intraoperative guidance for dissection during retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria. Method： In this series of 5 patients with chyluria, 3 patients with vascular abnormality revealed by preoperative ultrasonography and 2 patients without preoperative ultrasonography were subjected to MSCTA of renal vessels prior to retroperitoneoscopic renal pedicie lymphatic disconnection. Thefindings of MSCTA were compared with surgical findings and the effect of MSCTA On the operation was assessed. Result：The findings of MSCTA on renal vessels were consistent with those Of surgical exploration in the5 Pa-tients. Under the guidance of preoperative MSCTA, the normal and abnormal bilood vesses were fast identified. All patients were successfully cured by the retroperitoneoscopic procedure without injury of renal vessels. Themean operative time was （67.5±17.7） rain in patients without vascular abnormality and （91.7±22.5） min in the patients with vascular abnormality, respectively. Conclusion： MSCTA plays an important role in guiding retroper-itoneoscopic lymphatic disconnection for patients with chyluria, especially those with Vascular abnormality.