肾动脉CT成像在肾段动脉阻断肾部分切除术中的应用研究

目的为临床开展肾段动脉阻断的肾部分切除术提供影像解剖学指导。方法对390侧肾动脉CT成像（CTA）资料进行研究，分析肾动脉一级和二级分支处与肾门上下缘连线（A线）的关系，观察副肾动脉及支配情况。结果390侧肾动脉CTA资料研究结果显示：肾动脉第一级分支处在A线之内者为122例，占31．28％（122／390），在A线外侧者268例，占68．72％（268／390）。二级分支处在A线之外者187例，占47．95％（187／390）。副肾动脉共出现120侧128支，占30．77％（120／390），其中支配肾上极的副肾动脉共95支，占74．22％（95／128），支配肾下极者33支，占25．78％（33／128）。结论①肾动脉是呈节段性分布的，肾段动脉与肾门之间存在一定的空间，为肾段动脉阻断的肾部分切除术提供了安全保障；②副肾动脉出现机率较高，大部分支配肾上极，术中需注意保护副肾动脉，避免不必要的肾单位损伤；③CTA能够提供肾段动脉和副肾动脉的分布特点和个体变异情况，是选择性肾段动脉阻断。肾部分切除术前手术评估的重要手段。

The application study of CTA in partial nephrectomy with segmental renal artery clamping

Abstract] Objective To provide imaging with segmental renal artery clamping. Methods anatomic study guidance for partial nephrectomy We observed 390 cases of renal artery CT imaging （CTA） data, analyzed the relationship between the renal artery branches and the line A. Besides that, we also analyzed the location and dominance of the accessory renal artery. Results The number of the first order branch within the line A was 122, the rest were outside the line A. For the secondary branches, there were 187 cases outside the line A. Among the 390 cases, we discovered 120 cases that possessed the accessory renal artery. We found that 95 cases of accessory renal arteries dominated the upper pole of the kidney and 33 dominated the inferior pole. Conclusions ①The re nal artery shows segmental distribution characteristics, and there is enough space between the segmental renal artery and the renal hilum. This finding suggests that partial nephrectomy with segmental renal artery clamping is safe and feasible. ②Accessory renal arteries occurred with a certain probability, most of which dominate the upper pole of the kidney. So, we should pay attention to protect it for avoiding unnecessary nephron loss during the operations. ③CTA, which is an important method of preoperative surgical assessment, can reveal the distribution characteristics and individual variation of the segmental renal artery and accessory renal artery.