肾脏肿瘤术前螺旋CT肾动脉血管成像的应用价值

The Value of Renal Angiography with Multi-detector Spiral Computed Tomography in Preoperative Evaluation of Renal Neoplasms

目的了解肾脏肿瘤术前肾动脉的解剖及变异情况,为泌尿外科肾脏肿瘤切除术提供技术支持。方法利用多排螺旋CT血管造影三维重建技术(MSCTA)在术前显示肾脏肿瘤肾动脉的解剖起源及变异,并与手术中肾动脉血管分布情况进行对照。结果本组148例(296个肾脏)中肾动脉起源正常95例,解剖变异53例,肾动脉解剖变异占总病例数的35.81%(53/148),其中副肾动脉30.41%(45/148),副肾动脉变异中单侧出现副肾动脉20.95%(31/148),双侧出现副肾动脉9.46%(14/148);肾动脉提前分支占5.40%(8/148)。单侧肾动脉解剖变异发生率27.70%(41/148);双侧肾动脉解剖变异发生率8.11%(12/148);左肾2支副肾动脉解剖变异1例。不经肾门入肾的肾极动脉5例。MSCTA肾动脉解剖变异病例均在手术解剖分离中证实,符合率100%。结论术前MSCTA能清楚显示肾动脉起源及解剖变异,对临床肾肿瘤切除和避免血管损伤有重要应用价值。

Objective To evaluate the anatomy status of renal arteries in the patients with renal neoplasms before operation. Methods All patients with renal neoplasms were underwent with multi-detector spiral computed tomography arteriography （MSCTA ）.All the imaging were compared with the results of operation and pathology. Results 148 renal neoplasms were analyzed,95 cases showed normal anatomy and 53 cases showed variations of the renal artery.In the variations cases,30.41 %（45 /148）was accessory renal arteries （unilateral：20.95%;bilateral：9.46%）and 5.40 %（8 /148）was early-branching renal arteries.All the unilateral and bilateral variations were 27.70 % （41 /148 ）and 8.1 1 % （12 /148 ） respectively,one case with double left accessory renal artery and five cases with pole renal artery were observed.All MSCTA results were confirmed by the operation. Conclusion Preoperative MSCTA was a noninvasive methed and could show clear and reliable imaging for preoperative evaluation of renal neoplasms. It was important application value in clinical practice.