目的 应用多层螺旋CT(multi-slice spiral CT,MSCT)观测藏族成人肾动脉变异,为临床肾手术提供解剖学资料。 方法 回顾1218例接受全腹MSCT增强检查的藏族患者影像及临床资料,明确有无副肾动脉及肾动脉过早分支并计数,按性别及侧别进行统计分析。 结果 受试人群中副肾动脉检出率为32.59%(397例,95% CI 29.90%~35.22%),男性检出率为34.59%(247例,95% CI 32.10%~38.08%),女性检出率为29.76%(150例,95% CI 25.77%~33.75%),男、女检出率无统计学差异(Z=-1.771,P=0.077)。397例患者中共计519支副肾动脉,右侧53%(277/519),左侧46%(242/519)。右副肾动脉平均直径为(0.30±0.89)cm,左副肾动脉平均直径为(0.30±0.90)cm,双侧副肾动脉直径无统计学差异(t=0.045,P=0.964)。肾动脉过早分支检出率为25.86%(315例,95% CI 23.40%~28.32%),315例患者中共计358支肾动脉过早分支,右侧44%(161/358),左侧55%(197/358)。副肾动脉及肾动脉过早分支入肾位置均以肾门最为多见,分别占50.29%和55.87%。 结论 藏族人群中肾动脉变异占一定比例,术前明确肾动脉解剖变异对肾外科手术、肾移植以及介入手术治疗具有重要意义。
Abstract
Objective To observe the renal artery variation in Tibetan adults with multi-slice spiral CT (MSCT), and so as to provide anatomical data for clinical renal surgery. Methods The imaging data and clinical data of 1218 Tibetan patients who received whole-abdominal MSCT enhanced examination were retrospectively collected. By reading the MSCT images, the presence of accessory renal artery (ARA) and early branching of renal artery (EBRA) were determined and counted. Statistical analysis was conducted according to gender and side. Results ARA was found in 397 patients and the detection rate was 32.59% (95%CI 29.9%-35.22%). There were 247 males with a detection rate of 34.59% (95% CI 32.10%-38.08%) and 150 females with a detection rate of 29.76% (95% CI 25.77%~33.75%). There was no statistical difference in detection rate between males and females (Z=-1.771, P=0.077). There were 519 ARAs in 397 patients, 277 in the right kidney and 242 in the left kidney. The mean diameter of the right and left ARA were (0.3±0.89) cm and (0.3±0.9) cm, respectively. There was no significant difference in ARA diameter between two kidneys (t=0.045, P=0.964). EBRA was found in 315 patients and the detection rate was 25.86% (95%CI 23.40%-28.32%). There were 358 EBRA in 315 patients, 161 in the right kidney and 197 in the left kidney. Hilum was the most common location where ARA and EBRA entered the kidney, accounting for 50.29% and 55.87%, respectively. Conclusions The renal artery variation accounts for a certain proportion in Tibetan population. It is of great significance to identify the variation of renal artery anatomy before operation for renal surgery, renal transplantation and interventional surgery.
关键词
肾动脉 /
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肾动脉变异 /
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体层摄影术/X线计算机
Key words
Renal artery /
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Variation of renal artery /
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Tomography, X-ray computed
中图分类号:
 
R322.12
R322.61
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参考文献
[1] Klatte T, Ficarra V, Gratzke C, et al. A literature review of renal surgical anatomy and surgical strategies for partial nephrectomy [J]. Eur Urol, 2015, 68(6): 980-992. DOI: 10.1016/j.eururo.2015.04.010.
[2] 宋殿宾, 王志勇, 毕海, 等. 术中超声及术前辅助多层螺旋CT血管成像在阻断副肾动脉保肾手术中的效果观察[J]. 实用放射学杂志, 2020, 36(8): 1269-1272. DOI: 10.3969/j.issn.1002-1671.2020.08.023.
[3] Maleki H, Shahriar R, Kazemi R, et al. Frequencies of accessory renal arteries in 129 Iranian patients[J]. Am J Clin Exp Urol, 2020, 8(1): 38-42. PMID: 32211452.
[4] Cnar C, Turkvatan A. Prevalence of renal vascular variations: evaluation with MDCT angiography[J]. Diagn Interv Imaging, 2016, 97(9): 891-897. DOI: 10.1016/j.diii.2016.04.001.
[5] 孙凤涛, 张厚宁, 禹璐, 等. 256层螺旋CT肾动脉成像观察副肾动脉解剖结构[J]. 中国临床解剖学杂志, 2020, 38(5): 554-558. DOI: 10.13418/j.issn.1001-165x.2020.05.012.
[6] 冯志鹏, 张亚慧, 沈璟春, 等. 肾血管变异的基础与临床研究进展[J]. 局解手术学杂志, 2018, 27(8): 597-599. DOI: 10.11659/jjssx.05E017093.
[7] 蔡东升, 沈珈谊, 韦铁民. 副肾动脉与高血压相关性的临床研究进展[J]. 临床心血管病杂志, 2019, 35(12): 1148-1151. DOI: 10.13201/j.issn.1001-1439.2019.12.020.
[8] Vipparla N, Kichloo A, Albosta MS, et al. Resistant hypertension secondary to severe renal artery stenosis with negative duplex ultrasound: a brief review of different diagnostic modalities[J]. J Investig Med High Impact Case Rep, 2020, 8(12): 1-5. DOI: 10.1177/2324709620914793.
[9] 赵修义, 孙奔, 田军, 等. CT血管成像评估活体肾移植供者肾动脉变异的准确性及其误判原因分析[J]. 中华器官移植杂志, 2014, 35(5): 277-281. DOI: 10.3760/cma.j.issn.0254-1785.2014.05.006.
[10]张际青, 张小东. 副肾动脉定义商榷[J]. 中国临床解剖学杂志, 2010, 28(1): 109-110. CNKI: SUN:ZLJZ.0.2010-01-039.
[11]Palmieri BJ, Petroianu A, Silva LC, et al. Study of arterial pattern of 200 renal pedicle through angiotomography[J]. Rev Col Bras Cir, 2011, 38(2): 116-121. DOI: 10.1590/s0100-69912011000200009.
[12]沈珈谊, 吕玲春, 陈俊, 等. 浙西南地区中老年人群肾动脉影像解剖学特征[J]. 中国临床解剖学杂志, 2021, 39(5): 546-551, 556. DOI: 10.13418/j.issn.1001-165x.2021.05.009.
[13]庾汉华, 黄国慈, 杜妍妍. 256层螺旋CT在肾动脉变异评估中的价值[J]. 广州医科大学学报, 2021, 49(3): 96-99. DOI: 10.3969/j.issn.2095-9664.2021.03.20.
[14]仇剑. 肾动脉多排CTA的相关解剖学研究[D]. 长春: 吉林大学, 2014.
[15]Munnusamy K, Kasirajan SP, Gurusamy K, et al. Variations in branching pattern of renal artery in kidney donors using CT angiography[J]. J Clin Diagn Res, 2016, 10(3): AC01- AC03. DOI: 10.7860/JCDR/2016/16690.7342.