CTA技术在腹腔镜选择性肾段动脉阻断肾部分切除术中的应用

The Application of CT Angiography in Laparoscopic Partial Nephrectomy with Selective Segmental Renal Artery Blocking

目的评价腹腔镜肾部分切除术术前CT血管造影(CTA)指导下的目标阻断血管定位对手术的作用。方法回顾性分析2012年1月至2013年6月行腹腔镜选择性肾段动脉阻断肾部分切除术治疗的47例患者资料,术前均行肾血管CTA检查。均经腹膜后入路施行腹腔镜肾部分切除术,术中根据CTA提示寻找并阻断肾段动脉。结果 47例全部手术成功,无中转开放性手术。术中探查均发现CTA所提示的异常血管。所有通过术前CTA检查定位的血管均成功分离并阻断,47例阻断后达到满意的出血区域,准确率达到100%。结论腹腔镜肾部分切除术前行肾脏CTA检查能清晰显示血管的解剖及变异,有利于术中在CTA引导下选择性肾段动脉阻断,在有效切除肿瘤并保留正常肾实质的同时,使正常残余肾组织热缺血减少,有利于保存肾脏功能。

Objective To evaluate the application of preoperative CT angiography （CTA） in laparoscopic partial nephrectomy with selective segmental renal artery blocking. Methods During the period from January 2012 to June 2013 at authors＇ hospital, a total of 47 patients were treated with laparoscopie partial nephrectomy with segment renal artery blocking. Preoperative CTA was carried out in all patients. The clinical data were retrospectively analyzed. Laparoscopic partial nephrectomy was performed via retroperitoneal approach, and blocking of the corresponding segmental renal artery was conducted according to CTA findings. Results The procedure was successfully accomplished in all patients, and no conversion to open surgery was needed. Exploration during the operation showed that all the abnormal vessels detected by CTA could be found. All target vessels determined by preoperative CTA were successfully separated and blocked. The accuracy rate of CTA was 100%. Conclusion CT angiography performed before laparoseopic partial nephrectomy can clearly display the anatomy and variation of the renal artery, which is very helpful in guiding the performance of selective segmental renal artery blocking, the effective resection of tumor and the preservation of normal renal parenchyma at the same time, so that the warm isehemia of the normal residual kidney tissue will he decreased which is in favor of preservation of renal function.