| Objective:Aiming at serving for clinical surgery,it is potential to classify the right renal vein and summarize the characteristics of the extrarenal venous drainage of renal carcinoma by observing the morphological characteristics of the right renal vein under normal renal and clear cell carcinoma in multi-layer spiral CT angiography.Methods:Analyze the data from abdominal plain scan and enhanced scan on 100 patients without renal disease and 61 patients with right renal clear cell carcinoma.The original data were poet-processed including MPR(multi-plane reformation)and MIP(Maximum Intensity Projection).Then observe the right renal vein number,position,variation and extrarenal venous drainage of renal tumour,measure the relevant parameters(including the diameter and length of the renal vein,and the distance between adjacent two veins of multiple renal veins),and classify the right renal vein.Results:1.The number of right renal vein In 100 cases of normal group,single right renal vein was seen in 71 cases,among them,the late venous confluence in 23 cases,which the distance were within 15 mm between right renal vein branch confluence and postcava[1];multiple right renal veins were seen in 29 cases,of which two right renal veins in 26 cases,three right renal vein in3 cases.In 61 cases of tumorous group,single right renal vein was seen in 47 cases,of which the late venous confluence in 17 cases,multiple right renal veins were seen in 14cases,of which two right renal veins in 13 cases,three right renal veins in 1 case.2.The position of right renal vein into postcava In 132 right renal veins of the normal group,the right renal vein were located in postcava side wall 113 cases(85.6%)and in postcava back wall 19 cases(14.4%),among the later,single renal veins accounted for 17.6%(3/17),multiple renal veins accounted for 82.4%(14/17).In 76 right renal veins of the tumorous group,the right renal vein were located in postcava side wall 59 cases(85.6%),in postcava back wall 16 cases(14.4%),and in front wall 1 case(1.3%),in which the back wall,single renal vein accounted for 40%(6/15),multiple renal veins accounted for 60%(9/15).3.The measurement of right renal vein related parameters In normal group,the length and diameter of single right renal vein were about 20.24+ 8.08 mm and 12.39 + 2.16 mm,the shortest length and widest diameter of multiple renal veins were about 20.18 + 7.70 mm and 10.78 + 2.15 mm.The diameter of single right renal vein was slightly wider than that of the widest of multiple renal veins,with statistical significant difference(t=3.384,P=0.001<0.05).And the difference in length showed no statistical significance between single right renal vein and the shortest of multiple renal veins(t=0.037,P=0.971>0.05).In tumorous group,the diameter of the single renal vein was about 14.10 ± 3.56 mm in the tumor without extrarenal venous drainage of renal tumour,and the diameter was about 13.86 ± 4.27 mm in the tumor with extrarenal venous drainage of renal tumour.Compared with the diameter of the single renal vein in normal group,the difference in diameter in the tumor with extrarenal venous drainage of renal tumour was statistically significant(t=-2.589,P=0.013<0.05),suggesting that the diameter of the tumorous group was slightly wider;and the difference in diameter in the tumor without extrarenal venous drainage of renal tumour was not statistically significant(t=-1.219,P=0.244>0.05).In normal group,the distance between adjacent two veins of multiple renal veins was more than 8mm in 17 cases,and less than 8mm in 12 cases;in tumorous group,the distance was more than 8mm in 12 cases,and less than 8mm in 2 cases.4.The classification of right renal vein In normal group,type I,II,III and IV accounted for 48.0%(48/100),23.0%(23/100),13.0%(13/100)and 16.0%(16/100).In tumorous group,type I,II,III and IV accounted for 49.2%(30/61),27.8%(17/61),18.0%(11/61)and 4.9%(3/61).There was no significant difference in the classification of right renal vein between the normal group and the tumorous group(c2=4.959,P=0.175).5.The extrarenal venous return of renal tumour Extrarenal venous drainage of renal tumour were seen in 21 cases.Among them,13 cases were diverted into right genital vein,5 cases were diverted directly into postcava and 4 cases were diverted into the right adrenal vein.Compared to the patients without the breakthrough of renal capsule with malignancy,the emerge of extrarenal venous drainage of renal tumour with the breakthrough of renal capsule was statistically significant(c2=36.334,P<0.001).Compared with the tumor volume less than 4 cm,the emerge of extrarenal venous drainage of renal tumour was statistically significant in the tumour larger than 4 cm.(c2=8.319,P = 0.004 <0.05).Conclusion:Although the right renal vein into the inferior vena cava back wall,multiple renal veins and renal extracorporeal drainage veins are not common,it should not be neglected in laparoscopic surgery.MSCTA and its post-processing technology can show the right renal venous anatomical position,course,variation and extrarenal venous return of renal tumour from many directions and angles,which can provide surgeon with detailed,useful and comprehensive image data before surgery. |
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