CT的肾血流重建3D影像在内生型肾癌保留肾单位手术中的应用

Application of 3D renal blood flow in laparoscopic nephron sparing surgery for endogenetic kidney cancer

目的探讨CT的肾血流重建3D影像在内生型肾癌保留肾单位手术（LNSS）中的应用。方法术前通过肾肿瘤血流在CT增强中的“快进快退”表现，对患肾进行CT肾血流重建，旋转3D重建影像见肿瘤区域缺损。术中同轴旋转影像及。肾脏，根据缺损部位定位肿瘤，并进行LNSS。结果4例患者均完成LNSS，剥离出肿瘤均见包膜完整，肿瘤直径（2．2±0．5）cm。术中热缺血时间17～27min，平均21．7min。出血20—55mL，平均32mL。病理回示均为透明细胞癌。术后随访7个月一5年，患者血肌酐、尿素氮及碱性磷酸酶无明显变化，肾小球滤过率测定患肾功能无明显下降，CT均未见局部肿瘤复发。结论采用CT的肾血流重建3D影像帮助内生型T1a期肾癌的LNSS进行精准定位，该技术是安全、有效的，并且方法简便易行，利于推广。

Objectives To investigate the application of 3D renal blood flow in laparoscopic nephron sparing surgery（LNSS） for endogenetic kidney cancer by CT imaging. Methods All patients underwent CT renal blood flow reconstruction by ＂fast＂ manifestation of preoperative renal tumor blood flow in CT enhancement. All cases underwent LNSS by rotating the inmage and targeting the tumor. Results 4 patients were successfully completed LNSS, the tumor diameter was （2.2 ＋ 0.5） cm. Intraoperative ischemia time was 17 - 27min （ the mean time of 21.7min）, amount of bleeding （20 55mL, an average of 32mL）. The pathological change was clear cell carcinoma. The blood creatinine, blood urea nitrogen and alkaline phosphatase were not significantly differences during 7 - 60 months follow - up, and the renal function was not significantly decreased, and there was no tumor recurrence in CT. Conclusions 3D renal blood flow can realizes the fine accurate localization for the Tla phase endogenetic kidney cancer, and it is safe, simple and effective, and worth popularizing application in clinic.