CTA辅助的肾动脉分支阻断在腹腔镜保留肾单位手术中的应用价值(附11例报告)

Application value of CTA-guided renal artery branch clamping in laparoscopic nephron-sparing surgery(Report of 11 cases)

目的：探讨计算机断层扫描血管造影术（CTA）辅助的个体化肾动脉分支阻断在腹腔镜保留肾单位手术中的应用价值。方法：回顾性分析2012年10月～2013年12月行选择性肾动脉分支阻断的后腹腔镜保留肾单位手术11例患者的临床资料：肿瘤直径平均3．0（1．8～4．2）cm，其中1例为孤立肾肾癌。依据患肾CTA，术前制定个体化肾动脉分支阻断方案，其中阻断后支2例，阻断前支5例，阻断肾段动脉2例，阻断副肾动脉2例。术中观察出血量、视野清晰程度、阻断时间，术后观察并发症、肾功能。结果：11例手术过程顺利。术中按照术前制定的方案实施动脉阻断，其中有2例因肾创面渗血较多，改为动脉主干阻断。术中平均出血120（20～220）ml；平均阻断时间21（12～35）min，手术时间85（56～114）min术后平均引流90（30～150）ml，术后无漏尿发生。术后仅孤立肾肾癌肌酐暂时升高，7天后恢复至术前水平。结论：依据术前CTA，可在腹腔镜保留肾单位手术中制定个体化肾动脉分支阻断方案。此方法可操作性、安全性强，可以最大限度减少患肾缺血范围，保护肾功能。

Objective：To evaluate the application value of individual CTA-guided renal artery branch clamping in laparoscopic nephron-sparing surgery. Method：A retrospective analysis of retroperitoneal laparoscopic nephron- sparing surgery with selectively renal artery branch clamping in our hospital from October 2012 to December 2013 was made. A total of 11 cases included one ease of renal tumor in solitary kidney. Average diameter of tumor was 3.0 （range, 1.8-4.2） cm. According to preoperative CTA, we made individual renal artery branch clamping pro- gram, including two cases of ramus posterior arteriae renalis, five cases of ramus anterior arteriae renalis, two ca- ses of segmental renal artery and two cases of accessory renal artery. The blood loss, the extent of clarity in the surgical field, clamping time, operation time, postoperative complications and renal function were evaluated. Re- suit：All surgeries went smoothly. The renal artery branch damping programs were carried out according to the preoperative schedule, while two cases changed to the main renal arteries clamping because of heavy bleeding. The average operation time was 85 （range, 56-114） rain and the average blood loss was 120 （range, 20-220） ml. The average blocking time was 21 （range, 12-35） rain and the average postoperative drainage was 90 （range, 30-150） ml. No urinary leakage was found. The creatinine slightly increased postoperatively just in the case of solitary kid- ney, and then returned to preoperative level seven days later. Conclusion： Based on preoperative CTA, individual renal artery branch clamping program can be carried out in the laparoscopic nephron-sparing surgery. This tech- nique can reduce the extent of renal ischemia and protect the renal function as much as possible. Moreover, it＇s practical and safe.