【摘要】 目的 采用MDCT增强扫描探讨影响腹膜后腹腔镜肾癌根治性肾切除术(RLRN)手术操作的相关因素。方法 对87例临床诊断或拟诊肾癌的患者行CT增强扫描,通过重建图像观察并记录影响RLRN手术操作的相关因素。结果 (1)51例(58.6%)患者认定为无影响RLRN手术操作的因素,其共同CT特征是患侧肾周筋膜完整、肾后间隙存在、肾蒂结构清晰。(2)36例(41.4%)伴有不同程度影响RLRN手术操作的因素分别为:9例因肿瘤较大或位于肾脏后段,1例囊性肾癌和4例肾后间隙内存在异常回流静脉所影响肾后缘游离的因素;因肾动脉变异12例、肾静脉以及下腔静脉受侵或癌栓形成6例、肾盂积水1例,输尿管受压1例以及肾门部淋巴结转移2例所影响肾蒂结构分离结扎的因素。结论 增强MDCT图像观察肾后间隙和肾蒂结构能够为肾癌RLRN术前进行手术可行性的评价。更多还原

【Abstract】 Objective To approach the influencing factors of operative procedure at retroperitoneal laparoscopic radical nephrectomy(RLRN) for renal carcinoma evaluated by MDCT.Methods MDCT enhanced scanning was performed in 87 patients with renal carcinoma diagnosed clinically.The influencing factors no operative procedure at RLRN were recorded and classified through reconstructed images.Results(1) Fifty-one cases(58.6%) adapted RLRN had the following characteristics in common:with complete perirenal fascia,post-renal interspaces existing and clear renal pedicle.(2)36 cases(41.4 %)accompanied with adverse factors in two aspects.The factors affected of the dissection of post-renal interspaces included relative large tumor’s volume or situated in lateral renal parenchyma in 9 cases,cystic renal carcinoma in 1 case and abnormal venous drainage in 4 cases.Another aspect included renal pedicle ligation which influenced by renal artery variation in 12 cases,renal vein and inferior vena cava invaded or tumor thrombus in6 cases,hydronephrosis in 1 case,ureter pressure in 1 case and lymph node metastasis of renal hilum in 2 cases.Conclusion MDCT enhanced scanning can provide objective evaluation for feasibility of RLRN by observing posterior renal spaces and renal pedicle.更多还原