肾段的CT解剖及病变术前定位

CT anatomy of the renal segments and the diagnostic localization of space-occupying lesions

目的 探讨五个肾段的横断解剖分布特征及在病变术前CT定位诊断中的应用价值。 方法 将3例成年腹部连续横断层解剖标本和50例正常人中上腹部CT图像对照,观察肾动脉、肾静脉及其分支之间的关系及CT显示率,尝试以肾窦和肾静脉为标志划分肾段。对17例直径小于30mm的肾脏占位患者进行前瞻性的术前CT诊断与术后结果对照研究。 结果 在断层标本和常规平扫CT图像上,因肾动脉细小且位于肾静脉的下后方,故难以分辨肾动脉;在常规增强CT扫描中,肾动脉的显示率也仅48％。肾窦脂肪间隙清晰,与肾实质易于鉴别;肾静脉粗大且位于肾动脉前方,两者在肾窦内有相似的分支分布,故可借肾窦和肾静脉长轴作标志确定肾段。即肾窦所在区域的肾实质为前、后肾段,肾窦以外的肾实质近上极者为上段,近下极者为下段;位于肾静脉长轴后内侧的肾实质为后段。位其前外侧者为前段;前段仍借肾静脉长轴所在层面分为其上方的前上段和下方的前下段。本组17例肾脏占位病变术前CT定位、定性诊断与术后结果的CT一致率均达88％。 结论 以肾窦和肾静脉代替肾动脉作标志划分肾段简便、易行、准确性高,可用于小病灶的术前CT精确定位。

Purpose To explore the anatomic features of the renal segments on the axial section and the location-diagnostic value of the space-occupying lesions with CT. Methods The correlesion between sectional specimen of 3 cases adult cadavers and CT images of 50 cases normal abdomen were performed to observing the renal arteries , renal veins and renal sinus for segmenting the kidneys. The preopera-live CT location and the postoperative pathology were comparatively analyzed in the space-occupying lesion of 17 cases. Results The enal arteries were small , difficult be displayed on plain CT and conventional contrast scanning. The renal segments were convinently demarcated by the renal sinus and renal vein. The superior and inferior segments were defined as the superioinferior parts of the kidney without sinus respectively; the posterioanterior segments of the kidney were demarcated by the long axis of renal veins; and the anteriosuperior versus ante-rioinferior segmants of the anterior segment in kidneys could also be located by the renal veins. The accordance rate of preoperative location with CT and postoperative pathology of 17 space-occupying lesions was 88 percent. Conclusion Location of renal segments in the presentation is simple, practical and accurate.