CT三维重建在腹腔镜肾部分切除术中的应用价值

Application value of three dimensional CT reconstruction in laparoscopic partial nephrectomy

摘要:

目的 评价CT三维重建在腹腔镜肾部分切除术治疗肾肿瘤手术中的应用价值。 方法 回顾性分析2010年5月～2013年5月采用腹腔镜肾部分切除术治疗肾肿瘤23例。患者行多层CT非增强扫描后，然后行造影剂增强扫描，数据分析后行三维重建。肿瘤平均直径3.2 cm。 结果 CT三维重建图像清楚显示了23例患者的肾肿瘤。所有腹腔镜肾部分切除术均通过腹膜后入路成功完成。手术时间80～159 min，平均118 min。术中术后无严重并发症发生。病理结果：肾透明细胞癌T l期16例，肾血管平滑肌脂肪瘤7例，1例术中切缘阳性而改行肾癌根治术，其余22例切缘均为阴性。平均随访16个月，所有患者均无瘤生存，无肿瘤局部复发及其他脏器转移。 结论 CT三维重建能三维显示肿瘤及血管的解剖，可作为腹腔镜肾部分切除术治疗肾肿瘤术前常规影像学检查。

Abstract:

【Objective】 To evaluate the application value of three dimensional (3D) computed tomography (CT) reconstruction in laparoscopic partial nephrectomy for renal tumor. 【Methods】 From May 2010 to May 2013, a retrospective cohort study was conducted on the clinical data of 23 patients with renal tumor treated by laparoscopic partial nephrectomy. After unenhanced CT of the abdomen,a high-resolution contrast-enhanced scan was taken through the kidneys, data were analyzed by using muhiplanar reconstruction and three-dimensional reformatting. The mean diameter of renal tumor was 3.2 cm. 【Results】 Renal tumors were identified in the 23 patients evaluated with reconstructed images. 22 procedures were performed through retroperitonea1 approach and successful. The mean operative time was 118 min, ranging from 80 min to 159 min. No intraoperative or postoperative complication occurred. Postoperative pathological results included T1 renal cell carcinoma (RCC) in 16 patients and angiomyolipoma in 7, a patient had a positive surgical margin. During the follow up ranging from 3 to 38 months (median 16 months), neither local recurrence nor metastasis was observed. 【Conclusion】 CT with 3D reconstruction can provided a good map of renal tumor and vascular, which should become an imaging method for planning laparoscopic partial nephrectomy in patients with renal tumor.