| Objectives:1.Use CT primitive thin-layer renal vascular tracking technology to study the types,numbers and locations of renal vascular anatomical variations,and provide preoperative plans for renal tumor surgery.2.To explore the clinical application value of CT primitive thin-layer renal blood vessel tracking technology in laparoscopic renal tumor surgery.methods:1.Using retrospective research,collected 346 cases of abdominal CT plain scan +enhanced scan from December 1,2018 to June 30,2020 in the Second Affiliated Hospital of Nanchang University,and reconstructed into the original thin layer and abdominal CT angiography(CTA)The patient’s imaging data was analyzed to analyze the sensitivity of CT original thin layer and CTA to distinguish renal vascular variation.2.Collect the general data of 108 patients who underwent laparoscopic partial nephrectomy(LPN)in the urology department.The original thin layer of CT before operation was the experimental group,and the original thin layer of CT was not used but the control group was CTA.There were 57 cases in the original thin-slice CT group and 51 cases in the CTA group.The surgical data of the two groups were compared.62 patients underwent retroperitoneal laparoscopic radical nephrectomy(LRN).CT scans were performed before the operation,and the operation data of the LRN group were recorded after the operation.To evaluate the application value of CT original thin-layer renal blood vessel tracking technology for laparoscopic renal tumor surgery.results:1.A total of 346 patients underwent abdominal CT plain scan + enhanced scan and reconstructed into the original thin layer and CTA examination.A total of 183 patients with renal artery variation were found in the original thin layer of CT,and the variation rate was 52.9%.Type I(1 blood vessel variation)There are 118 cases,type II(2-vessel variation)has 53 cases,type III(3-vessel variation)has 10 cases,and type IV(4-vessel variation)has 2 cases.CTA found a total of 141 patients with renal artery variation,and the variation rate was 40.8%.There were 94 cases of type I(1 blood vessel variation),41 cases of type II(2 blood vessel variation),and type III(3 blood vessel variation).In 6 cases,no type IV(4-vessel variant)was found.The original thin layer of CT revealed that the rate of renal artery variation was significantly higher than that of CTA,and the difference was statistically significant(c2=12.04,P<0.05).A total of 96 patients with renal venous variation were found on CT original thin layer,and the variation rate was 27.7%.A total of 79 patients with renal artery variation were found by CTA,and the variation rate was 22.8%.The original thin layer CT and CTA showed no significant renal venous variation.Difference(c2=2.365,P>0.05).2.The operation time of the original thin-layer CT group and the CTA group under LPN were(66.75±5.61)min and(79.84±6.03)min,respectively,and the difference between the two groups was statistically significant(P<0.05);Moderate warm ischemia time was(22.37±2.33)min and(25.98±1.99)min,and the difference between the two groups was statistically significant(P<0.05);intraoperative blood loss was(63.26±6.46)ml,respectively And(77.94±8.67)ml,the difference between the two groups was statistically significant(P<0.05);the number of cases without blood transfusion and the number of open cases in the CT original thin-layer group,the number of blood transfusion cases and the number of open cases in the CTA group There were 2 cases,and there was no statistically significant difference between the two groups(P>0.05);24h postoperative drainage volume was(48.07±7.67)ml and(50.59±8.16)ml,respectively.There was no statistical difference between the two groups.Scientific significance(P>0.05);the changes of creatinine before and after the operation were(12.18±2.78)umol/L and(12.61±3.41)umol/L,there was no significant difference between the two groups(P>0.05));postoperative drainage tube removal time was(5.61±0.73)d and(6.24±1.21)d,respectively,there was no significant difference between the two groups(P>0.05);postoperative hospital stay was(6.23± 1.12)d and(5.96±1.15)d,the difference between the two groups was not statistically significant(P>0.05).The postoperative histopathological diagnosis of the two groups was renal cell carcinoma,and the clinical stage was T1N0M0.The margins are all negative.The operation time of the LRN group was(52.34±8.72)min, the intraoperative blood loss was(40.03±9.56)ml,the drainage volume was(25.19±5.90)ml after 24 hours,and the postoperative drainage tube removal time was(4.92± 1.03)d,the postoperative hospital stay was(6.10±0.95)d,and there were no cases of open transfer and blood transfusion.conclusions:1.The original thin layer of CT is more sensitive than CTA in observing renal artery variation.2.CT original thin-layer renal blood vessel tracking technology can accurately display the anatomical type,number and surrounding tissues of renal artery variants.It can not only guide the operation of laparoscopic renal tumors,but also has certain application value in other urinary system operations.Better guarantee the safety of surgical patients.It can be used as the preferred preoperative examination method for laparoscopic kidney surgery. |
