| Objective:Assess applied value of multislice spiral CT angiography in nephron-sparingsurgery for renal cancer,to guide the rapid control of renal blood vessels in thenephron sparing surgery,reduce the intraoperative blood loss,to avoid damageto renal artery, reduce the operation risk, protect kidney function moreefficiently.Methods:Choice in May of2010,5to2012,5menstrual check-up or check for otherdisease, B ultrasonic or CT detection of60cases of kidney tumor, tumordiameter4.0cm or less, are single.Preoperative routine Urinary systemultrasound, CT or MRI, including30cases of MSCTA in CT examination atthe same time. renal function(creatinine, urea nitrogen),and surgery kidneyglomerular filtration rate（,GFR）determination.They were randomized into thetwo group,MSCTA group and non MSCTA group.Two groups of patients withgender, age, tumor location, tumor size, renal, surgery kidney GFRdetermination are comparable.By MSCTA with one doctor CT examination,and two experienced urological surgeon, Dr. and read the CT by twodoctor.According to MSCTA of vascular anatomical form, determine thecorresponding surgery path and blood vessel blocking method. With the lateralincision between the11th rib,conventional lines retain nephron sparingsurgery,detailed record the operation time, intraoperative warm ischemia timeand blood loss, Postoperative3months renal function and postoperative6months surgery kidney GFR determination and complication rates.Using SPSS17.0on two groups of operation time, intraoperative warm ischemia time,blood loss, pull out renal week average hospital stay, postoperative drainage tube time, postoperative complications, efficacy for independent samples ttest.Two groups of patients with preoperative and postoperative3monthsrenal function, Postoperative6months surgery kidney GFR determinationbetween groups compared with paired t test.Adopt (x±s), P value is less than0.05will be considered a test of the difference was statistically significant.Results:MSCTA group of30patients with renal arteries in number1～3branch,23cases have1bottle of renal artery,5cases have2bottle of renal artery,2cases have3bottle of renal artery, and found39branches renal arteries inall.10cases found bilateral renal artery in the ill side, consistent with thenumber of renal artery was found during operation.Control adrenal arteryinjury in the operation in5cases, cause local blood supply obstacles, and thepartial nephrectomies. And MSCTA group checked out2and3renal artery,intraoperative are free out of the block at the same time, with no damage in1case.MSCTA group and non MSCTA group the average surgery time were(77.83±7.39)min and (99.17±10.01)min, intraoperative thermal ischemia timeon average were (15.47±1.80)min and (29.93±3.43)min, intraoperative bloodloss on average were (93.67±27.35)ml and (157.67±20.79)ml, Differencesbetween the two groups have statistical significance(p<0.05).MSCTA group ofpreoperative and Postoperative6months surgery Kidney GFR determinationwere (54.17±3.63)ml/min and (49.20±2.58)ml/min,Non MSCTA group ofpreoperative and Postoperative6months surgery Kidney GFR determinationwere (52.50±4.58)ml/min and (34.20±3.27)ml/min.MSCTA group ofpreoperative and postoperative3mouths urea nitrogen, creatinine, andPostoperative6months surgery kidney GFR determination, there were nostatistically significant differences(P>0.05),Non MSCTA group ofpreoperative and postoperative3mouths urea nitrogen, creatinine, there wasno statistically significant difference(P>0.05), but and Postoperative6monthssurgery Kidney GFR determination comparative differences are statisticallysignificant (P<0.05).Postoperative3months review urea nitrogen, creatinine,surgery kidney CT,6months review surgery kidney GFR determination.Two groups of patients had no secondary bleeding, renal failure and tumorrecurrence or metastasis. Two groups each have1case of urinary fistula undercystoscope D-J tube placement in conservative treatment.Conclusions:MSCTA can clear display three-dimensional distribution of renal arteryand its branches, the presence of vascular anatomical abnormalities andmalformations, vascular cavity presence of narrow, tube wall has withoutpathological changes, with or without abnormal increase in tumor bloodvessels and collateral circulation of tumor and surrounding blood vessels andsurrounding tissues and organs of the three-dimensional relationship,Renalvein and inferior vena cava tumor emboli, also can better display abnormalveins anatomy and tumor abnormal venous return,and can guide treatmentquickly and accurately in the renal blood vessels, shorten the intraoperativewarm ischemia time, Avoid adrenal artery injury,Maximum limit retainedkidney tissues,conducive to the postoperative recovery of renal function, at thesame time does not increase the patients economic burden, can be used asRenal cancer NSS preoperative routine inspection. |
