CT重建及CTA技术在腹腔镜肾脏手术中的应用价值

Clinical application of reconstruction of CT and CTA in laparoscopic renal surgery

目的探讨术前行多层螺旋CT增强扫描+三维重建+肾血管成像技术(MSCTA)在肾脏手术中的应用价值。方法选取我科2016年1至2016年12月收治的200例腹腔镜肾脏手术患者,随机分为两组,其中试验组100例,采用术前行MSCT检查并行肾血管重建及肾脏三维重建,了解患者肾脏病灶冠状位结构及血管与病变关系;对照组100例,术前仅CT平扫+增强扫描检查。手术后,比较两组患者的不良反应发生情况、术中改开放手术例数、手术时间、术中出血量、术后渗血量及平均住院时间。结果试验组能提供病变更直观冠状位图像,且无1例出现不良反应,能清楚显示肾动脉支数及变异,甚至瘤体二级血供或异位血管压迫输尿管等特殊情况;其中改开放手术患者10例,均为对照组;试验组手术时间为(58.7±9.5)min,明显短于对照组(89.1±13.5)min(P<0.05);试验组术中出血为(46.5±7.0)m L,明显少于对照组(97.3±16.8)m L(P<0.05);试验组术后渗血量为(31.5±9.7)m L,明显少于对照组(86.7±30.2)m L(P<0.05);术后,试验组肠功能恢复时间为(2.0±0.5)d,明显短于对照组的(3.0±1.0)d(P<0.05);术后,试验组总住院时间为(8.2±1.3)d,明显短于对照组的(12.8±1.6)d(P<0.05)。结论三维CT及CT肾动脉成像技术安全、快捷、无创,可清楚显示肾动脉及其主要分支情况,结合肾脏三维重建,能在术前明确病变范围、病因、为术者制定精准治疗方案,最大限度降低肾脏手术风险,显著提高手术安全性,缩短手术时间,减少出血及术后渗血量,减少平均住院时间,不仅对于泌尿系肾脏疾病,也对其他相关外科疾病及介入诊疗有帮助,前景广阔,值得各级医院广泛推广。

Objective To evaluate the value of muhislice spiral computed tomography （MSCT） plus three-dimensional reconstruction and renal angiography （MSCTA） in renal surgery. Methods Two-hundred cases of patients with laparoscopic renal surgery from January 2016 to December 2016 in our department were collected and randomly divided into two groups. The experimental group （100 cases） were treated with MSCT and renal three-dimensional reconstruction before renal angioplasty to understand the renal lesion coronal structure and the relationship between blood vessels and lesions. The control group （100 cases） only received preoperative CT scan ＋ enhanced scan. The postoperative adverse events, numbers of open surgery, operation time, intraoperative hemorrhage, the amount of postoperative bleeding, intestinal function recovery time and the average length of hospital stay were recorded and compared in the two groups. Results The experimental group could provide a more direct coronal image of the lesion, and no adverse reactions occurred, it could clearly show the number and variation of renal artery, even the secondary blood supply or special cases of ectopic vascular compression of the ureter. The control group was converted to open surgery in 10 cases. The operation time of the experimental group was （58.7±9.5） rain, which was obviously shorter than （89.1±13.5） min of the control group （P〈0.05）; the intraoperative hemorrhage of the experimental group was （46.5±7.0） mL, which was obviously less than （97.3±16.8） mL of the control group （P〈0.05）; the postoperative bleeding of the experimental group was （31.5±9.7）mL, which was obviously less than （86.7±30.2） mL of the control group （P〈0.05）; after the operation the intestinal function recovery time of the experimental group was （2.0±0.5） d, which was obviously shorter than （3.0±1.0） d of the control group （P〈0.05）; the total hospital stay of the experimental group was （8.2±1.3） d, which was obviously shorter than （12.8±1.6） d of the control group （P〈0.05）. Conclusion Three-dimensional CT and CT renal artery imaging technique are safe, rapid and noninvasive, which can clearly show the renal artery and its main branches. Combined with three-dimensional reconstruction of the kidney, it can clearly define the lesion area and etiology before the operation. It can provide accurate treatment program, minimize the risk of renal surgery of the operation, significantly improve the safety, shorten the operation time, reduce bleeding and postoperative bleeding, reduce the average length of stay. It can not only be used for the urinary system of kidney disease, but also for other related surgical diseases and interventional treatment, the prospect is broad, it is worthy of extensive promotion of all levels of hospitals.