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目的:评价多层螺旋CT血管成像(MSCTA)在后腹腔镜肾蒂淋巴管结扎术中的应用。方法:对3例术前超声诊断肾血管变异和2例未进行血管超声检查的乳糜尿患者,在后腹腔镜肾蒂淋巴管结扎术前行MSCTA肾血管扫描,比较MSCTA发现和术中所见,评价MSCTA检查对手术的指导意义。结果:5例MSCTA显示的血管数目、走行完全与术中所见一致。在MSCTA的指引下,2例患者肾脏的正常血管和3例患者的主要血管、变异血管被快速定位,血管周围淋巴管被顺利结扎。5例患者均顺利进行后腹腔镜手术治疗,无肾血管损伤。无血管畸形患者平均手术时间(67.5±17.7)min,肾血管畸形患者平均手术时间(91.7±22.5)min。术后乳糜尿消失。结论:MSCTA对后腹腔镜肾蒂淋巴管结扎术有重要的指导意义,特别是在肾血管存在变异的患者。
Objective: To evaluate the application of multi-slice spiral CT angiography (MSCTA) in retroperitoneal laparoscopic nephral lymphatic ligation. Methods: Three patients with preoperative renal ultrasound diagnosis of renal vascular variability and 2 patients without vascular ultrasound were retrospectively performed MSCTA renal vascular scan before retroperitoneal laparoscopic renal pedicle lymphatic drainage. Compared with MSCTA findings and intraoperative findings , Evaluate the MSCTA examination of the guiding significance of surgery. Results: The number of vessels showed by MSCTA in 5 cases was completely consistent with that seen in the operation. Under the guidance of MSCTA, the normal blood vessels of the two patients and the major blood vessels and blood vessels of the three patients were rapidly located, and the perivascular lymphatic vessels were successfully ligated. All 5 patients underwent laparoscopic surgery without renal vascular injury. The average operation time of patients without vascular malformations was (67.5 ± 17.7) min and that of patients with renal vascular malformations was 91.7 ± 22.5 min. Postoperative chyluria disappeared. Conclusion: MSCTA has an important guiding significance for retroperitoneal laparoscopic renal pedicle lymphatic ligation, especially in patients with variant renal vessels.