Application Of There-dimensional Helical CT Angiography In Laparoscopic Radical Nephrectomy And Laparoscopic Partial Nephrectomy

Objective To discuss the category of the variations of renal artery and left renal veinwith64-slice spiral CT angiography.To evaluate the application of there-dimensionalhelical CT angiography in laparoscopic radical nephrectomy and Laparoscopic partialnephrectomyMethods From October2009to October2011,87hospitalized cases with localizedrenal cell carcinoma were collected.Retroperitoneal LRN was performed in76patients.Thirty-nine cases underwent CTA before LRN，volume rendering and maximum intensityprojection of renal artery were used as three-dimensional reconstruction. The other37without CTA were compared as control. Treatment outcomes of the two groups werecompared，including operation time, blood lose,conversion to open surgery，hospitalizationstay after operation, hospitalization expenses. LPN was performed in11patients. All casesunderwent CTA before LPN. And we recorded the outcomes including blood lose、operation time、warm ischemia time、hospitalization stay after operation, and complicationsafter operation. The variations of renal vessels were observed and classified bythere-dimensional CT.Results①All LRN were completed with no conversion to open surgery in CTAgroup.Three patients underwent conversion to open surgery in the control gr-oup. In CTAand control group, the operation time was (52.33±7.89)min and (66.24±8.17)min(P<0.05), blood loss was (35.10±9.23)ml and (50.08±8.52)ml((P<0.05),24hours lead flow after operation was (23.72±5.34)ml and (33.57±6.74)ml(P<0.05),hospitalization stay after operation was (7.31±0.95)d and (8.05±0.91)d(P<0.05), hospitalization expenses was (14117.95±1631.90)and(16140.54±1811.15)yuan(P<0.05).All LPN were completed with no conversion to ope-n surgery. The operation time was(105.71±25.64) min, blood loss was (135.26±36.78)ml,the warm ischemia time was(25.68±5.93)min, hospitalization stayafter operation was (9.51±1.83)d. The pathologicexamination showed negative surgical margin in all cases;②The incidence of thevariations on renal arterywas56%(28/50). Category I renal artery variation was64.29%(18/28); category II was28.57%(8/28); category III was7.14%(2/28). The totalnumber of variati-ons was40. Among them,25renal arteries originated from abdominalaorta,11renal arteries originated from dominant renal artery,4renal arteries originatedfrom the branches of abdominal aorta. Variation branch of renal arteries ent-ered the upperkidney pole in20arteries, entered the renal hilus in10, and entered the lower pole in10.Conclusions①The3D CT angiography can accurately display the origin、number、size、branching pattern、course、and relationship with the renal artery、collection system、adjacent tissue,and it can be to work out a surgical programme provides an objective basis.②The renal artery variation have individual and diverse characteristics.③The3D CTangiography can be used as an effective method in evaluating kidney vessels variation. InLRN and LPN,it can shorten the operation time,reduce the blood loss and24hours leadflow after operation.And it can shorten the warm ischemia time,reduce renalischemic-reperfusion injury in LPN. And it could reduce hospitalization expenses anddecrease the burden of patients.