螺旋CT肾动脉成像在肾脏肿瘤术前评估中的意义

The value of renal CT arteriography in the pre-operation evaluation of patients with renal tumors

目的探讨螺旋CT肾动脉成像（CTA）在肾脏肿瘤术前评估中的意义。方法对372例肾癌患者进行16排螺旋CT（Philips Brilliance16）平扫，并注射造影剂欧乃派克后分别进行动、静脉期扫描、延迟扫描，了解患肾的动脉变异情况。并在图像工作站中进行后期处理，进行肾动脉重建，为手术提供依据。结果372例患者中有21例为孤立肾，4例为双侧肾脏均有肿瘤；372例患者中376个患肾共检出120个肾有肾动脉变异，检出率为31．9％，其中12．2％（46／376）的患肾肾动脉过早分支，19．7％（74／376）的患。肾中存在副肾动脉，其中10个肾存在两根副肾动脉，其余均为一根，共84根；副肾动脉中7．2％（7／84）的由膈动脉发出，大部分[91．7％（77／84）]由腹主动脉发出，两者构成比比较差异有统计学意义（X^2=65．68，P〈0．01）；副肾动脉进入肾脏部位分别为：进入肾上极的占65．5％（55／84），中部占19．0％（16／84），下极占15．5％（13／84）。218例患者术前普通CT扫描发现44例存在肾动脉变异[20．2％（44／218）]，然后行CTA血管重建后发现63例存在肾动脉变异[28．9％（63／218）]，CTA重建后肾动脉变异发现率高于肾动脉重建前，其差异有统计学意义（X^2=4．47，P〈0．05）。CTA发现肾动脉变异的63例手术患者，术中60例找到肾动脉变异，3例术中未找到[4．8％（3／63）]。结论螺旋CT平扫增强发现肾动脉变异存在一定局限性，CTA能清晰显示肾动脉的数目和变异，为制定肾肿瘤手术方案提供可靠的依据。

Objective To investigate the value of renal CT arteriography in the preoperation evalu- ation of patients with renal tumors. Methods From Jan 2007 to June 2012, 372 patients with renal tumors took renal CT arteriography （with Pbilips Brilliance 16 ） to evaluate the variations of their renal arteries. We executed plain scan first, then artery phase, venous phase scan and delaying scan by turns after injections of Omnipaque. All images were delivered to imaging workstation and reconstructed to 3D views of renal arteries to supply imageological supports for surgeons. Results Tumors in solitary kidneys were detected in 21 pa- tients, and masses in both kindneys were detected in 4 cases. We collected data of 376 kidneys finally. We found premature branching renal arteries on 46 kidneys （ 12. 2% ） and accessory renal arteries on 74 kid- neys （ 19. 7% ）. Double accessory renal arteries were seen on 10 kidneys （2. 7% ）, and there were 84 ac- cessory renal arteries in summary. 7 accessory renal arteries （7.2%） came from arteria phrenica and 77 （91.7%） came from abdominal aorta （X^2=65.68, P 〈0, 01 ）. We found the regions where the accessory renal arteries entered kidneys： 65. 5% （55/84） in upper poles, 19. 0% （16/84） in central regions and 15. 5% （13/84）in inferior poles. Routine CT scans found 44 variations of renal arteries in 218 cases who underwent surgeries, and then renal CT arteriography found 63 variations in the same cases （ 20. 2% vs 28.9% , X^2 =4.47, P 〈0.05）. Finally, surgeons found 60 variations of renal artries in operations in the 63 cases with variations found by renal CT arteriography before surgeries. Conclusions There is limitations of routine CT scan （plain scan and with contrast medium） in detection of renal artery variations. Renal CT ar- teriography can supply reliable supports for establishment of surgical plans for renal tumors.