摘要
目的探讨基于肾血管CT三维重建检查结果的改良右肾动脉离断法在经腹腹腔镜右肾癌合并静脉癌栓切除术中的应用效果。方法回顾性分析2016年1—6月于山东第一医科大学附属省立医院行全腹CT平扫加增强检查的70例患者的肾血管CT三维重建图像,男41例,女29例。平均年龄47.5(33~75)岁。CT检查结果示主动脉与下腔静脉之间存在较大间隙,为脂肪和淋巴组织;在矢状面上主动脉右侧缘,右肾动脉位于左肾静脉上方14例(20.0%)、后方33例(47.1%)、下方23例(32.9%);在矢状面上下腔静脉左侧缘,右肾动脉位于左肾静脉上方1例(1.4%)、后方26例(37.1%)、下方43例(61.4%)。基于此,回顾性分析2016年6月至2019年12月山东第一医科大学附属省立医院收治的11例右肾癌合并静脉癌栓患者的病例资料。男7例,女4例。平均年龄(58.7±6.8)(45~68)岁。术前肾血管CT三维重建检查:在矢状面上主动脉右侧缘,右肾动脉位于左肾静脉后方7例,下方4例;在矢状面上下腔静脉左侧缘,右肾动脉位于左肾静脉后方3例,下方8例;肾肿瘤位于中上部5例,中下部6例;肿瘤最大径线(10.0±1.4)(8.5~12.0)cm;合并Mayo 0级癌栓4例,Ⅰ级癌栓4例,Ⅱ级癌栓3例。11例均行经腹腔入路腹腔镜手术,术中观察在矢状面上主动脉右侧和下腔静脉左侧缘,右肾动脉与左肾静脉的关系与术前肾血管CT三维重建检查结果一致。采用改良右肾动脉离断法,即在下腔静脉与主动脉之间,以左肾静脉为标志,挑起左肾静脉和下腔静脉容易发现右肾动脉,结扎并离断右肾动脉后切除右肾及静脉癌栓。结果本组11例手术均顺利完成。手术时间(110.5±29.8)(70~150)min,游离右肾动脉时间(28.5±5.8)(16~33)min;术中出血量(112.7±83.5)(20~300)ml,11例术中均未发生严重并发症。术后病理类型:透明细胞癌10例,乳头状细胞癌1例。术后住院时间(4.2±0.8)(4~7)d,11例均无继发出血、感染、下肢静脉血�
Objective To explore the advantages of the modified right renal artery dissection in the laparoscopic resection of right renal carcinoma combined with venous tumor thrombus.Methods From January 2016 to June 2016,a retrospective analysis of the three-dimensional CT images of renal blood vessels in 70 patients with full abdominal CT plain scan plus enhanced scan from Shandong Provincial Hospital Affiliated to Shandong First Medical University was performed.On the sagittal plane of the right margin of the aorta,the right renal artery was detected to locate above the left renal vein in 14 cases(20.0%),posterior in 33 cases(47.1%),and below in 23 cases(32.9%).In addition,on the sagittal plane of the left margin of the inferior vena cava,the right renal artery was detected to locate above the left renal vein in 1 case(1.4%),posterior in 26 cases(37.1%),and below in 43 cases(61.4%).Based on this finding,11 patients with right kidney cancer combined with venous tumor thrombus,admitted to Shandong Provincial Hospital Affiliated to Shandong First Medical University from June 2016 to December 2019,were retrospectively analyzed.The average age of the patients was(58.7±6.8)(45-68)years old.The CT three-dimensional reconstruction of the renal blood vessels was shown on the sagittal plane of the right margin of the aorta before the operation,and the right renal artery was detected to locate above the left renal vein in 0 cases,posterior in 7 cases,and lower in 4 cases.On the sagittal plane of the left margin of the inferior vena cava,the right renal artery was detected to locate above the left renal vein in 0 case,behind in 3 cases,and below in 8 cases.Renal tumors are located in the upper middle in 5 cases and in the lower middle in 6 cases.The maximum diameter of the tumor to be resected was 8.5-12.0 cm,with an average of(10.0±1.4)cm.Among them,4 cases had Mayo grade 0 tumor thrombus,4 cases were gradeⅠtumor thrombus,and 3 cases were gradeⅡtumor thrombus.All 11 cases underwent transperitoneal laparoscopic surgery.During
作者
晁宝婷
吕家驹
孙亮
刘征
宁豪
吴海虎
牛志宏
高德轩
Chao Baoting;Lyu Jiaju;Sun Liang;Liu Zheng;Ning Hao;Wu Haihu;Niu Zhihong;Gao Dexuan(Department of Radiology,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China;Department of Urology,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2021年第10期730-734,共5页
Chinese Journal of Urology
关键词
癌
肾细胞
癌栓
腹腔镜
右肾动脉
左肾静脉
Carcinoma,Renal cell
Tumor thrombus
Laparoscopy
Right renal artery
Left renal vein
