融合肾锥体的解剖结构
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摘要
目的:研究融合肾锥体的发生情况及解剖结构,为经皮肾镜碎石取石术的精准穿刺提供解剖学依据。方法:2017年5月-2018年1月,共选取105个新鲜猪肾进行解剖。统计融合肾锥体的发生情况,包括融合肾锥体在上、中、下组肾盏中的发生率,中组肾盏不同程度融合肾锥体的特征及其比例,中组肾盏肾锥体融合的个数及其比例。结合组织切片对比研究融合肾锥体及肾柱内的血管分布。结果:融合肾锥体具有很高的发生比例,肾脏上下极尤为明显。上、下组肾盏的肾锥体常常发生大片状融合。中组肾盏以2个肾锥体融合多见,融合的程度则以重度多见。融合肾锥体内存在叶间动脉走行,但界限不清,且缺乏坚韧的结缔组织保护,常常发生变异。结论:融合肾锥体是肾脏常见的解剖结构,叶间动脉分布于融合肾锥体内。由融合肾小盏引导的常规经皮肾穿刺可能会导致融合肾锥体内异位叶间动脉的严重损伤。
Objective: Based on the accurate puncture of percutaneous nephrolithotomy(PCNL), to study the occurrence and anatomical structure of the fused renal pyramid(FRP). Methods: A total of 105 porcine kidneys were selected for the assessment of regional anatomy. The frequency of FRP were analyzed,including the incidence of the FRP in upper, middle, and lower group calyx, and the proportion of fused degree and fused pyramidal number in middle group calyx was calculated. Combining with tissue slices, we comparatively studied the vascular anatomy of the FRP and renal column. Re.sults: The FRP had a high incidence, especially the upper and lower group calyx in which renal pyramids often merged into a large flake. In the case of middle group calyx, the fusion of two renal pyramids and the severe fused type were more common. Interlobar arteries were found in the FRP, but their boundary was unclear and lack of protection of dense connective tissue. Conclusion: The FRP is a common anatomical structure in the kidney, and the interlobar artery distributes within the FRP.Routinely percutaneous renal puncture guided by the fused renal calyx, neglecting the potential vascular variation, may result in serious injury to the ectopic interlobar artery in FRP.
Objective: Based on the accurate puncture of percutaneous nephrolithotomy(PCNL), to study the occurrence and anatomical structure of the fused renal pyramid(FRP). Methods: A total of 105 porcine kidneys were selected for the assessment of regional anatomy. The frequency of FRP were analyzed,including the incidence of the FRP in upper, middle, and lower group calyx, and the proportion of fused degree and fused pyramidal number in middle group calyx was calculated. Combining with tissue slices, we comparatively studied the vascular anatomy of the FRP and renal column. Re.sults: The FRP had a high incidence, especially the upper and lower group calyx in which renal pyramids often merged into a large flake. In the case of middle group calyx, the fusion of two renal pyramids and the severe fused type were more common. Interlobar arteries were found in the FRP, but their boundary was unclear and lack of protection of dense connective tissue. Conclusion: The FRP is a common anatomical structure in the kidney, and the interlobar artery distributes within the FRP.Routinely percutaneous renal puncture guided by the fused renal calyx, neglecting the potential vascular variation, may result in serious injury to the ectopic interlobar artery in FRP.
引文
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[12]Rana AM,Bhojwani JP.Percutaneous nephrolithotomy in renal anomalies of fusion,ectopia,rotation,hypoplasia,and pelvicalyceal aberration:uniformity in heterogeneity[J].J Endourol,2009,23(4):609-614.
[13]Rodrigues PL,Rodrigues NF,Fonseca J,et al.Kidney targeting and puncturing during percutaneous nephrolithotomy:recent advances and future perspectives[J].J Endourol,2013,27(7):826-834.
[14]Roy OP,Angle JF,Jenkins AD,et al.Cone beam computed tomography for percutaneous nephrolithotomy:initial evaluation of a new technology[J].J Endourol,2012,26(7):814-818.
[2]Kallidonis P,Kalogeropoulou C,Kyriazis I,et al.Percutaneous nephrolithotomy puncture and tract dilation:evidence on the safety of approaches to the infundibulum of the middle renal calyx[J].Urology,2017,16(7):43-48.
[3]Hwang Y,Shin YR,Lee SL,et al.Ultrasound-guided percutaneous biopsy of the native kidney:an axial approach along br鰀el avascular plane of the lower pole[J].Ultrasound Q,2017,33(2):144-147.
[4]Sampaio FJ.Renal anatomy.Endourologic considerations[J].Urol Clin North Am,2000,27(4):585-607.
[5]韩行敏,王力阁,吴学军,等.猪肾及肾段的解剖学观察[J].黑龙江畜牧兽医,2002,4:23-24.Han XM,Wang LG,Wu XJ,et al.Anatomical observation of the kidney and kidney segment of the pig[J].Heilongjiang Journal of Animal Science and Veterinary Medicine,2002,4:23-24.
[6]Türk C,Petk A,Sarica K,et al.EAU guidelines on interventional treatment for urolithiasis[J].Eur Urol,2016,69(3):475-482.
[7]Turna B,Nazli O,Demiryoguran S,et al.Percutaneous nephrolithotomy:variables that influence hemorrhage[J].Urology,2007,69(4):603-607.
[8]Said SH,Ma AKH,Ali RH,et al.Percutaneous nephrolithotomy;alarming variables for postoperative bleeding[J].Arab J Urol,2017,15(1):24-29.
[9]Keoghane SR,Cetti RJ,Rogers AE,et al.Blood transfusion,embolisation and nephrectomy after percutaneous nephrolithotomy(PCNL)[J].BJU Int,2013,111(4):628-632.
[10]Song Y,Fei X,Song Y.Percutaneous nephrolithotomy guided solely by ultrasonography:a 5-year study of>700 cases[J].BJU Int,2013,112(7):965-971.
[11]孙颖浩,高小峰,来丽丽,等.超声引导微创经皮肾镜碎石取石术治疗复杂性肾结石[J].上海医学,2004,27(5):307-308.Sun YH,Gao XF,Lai LL,et al.Minimally invasive percutaneous nephrolithotomy under ultrasound guidance for treatment of complex renal calculi[J].Shanghai Med J,2004,27(5):307-308.
[12]Rana AM,Bhojwani JP.Percutaneous nephrolithotomy in renal anomalies of fusion,ectopia,rotation,hypoplasia,and pelvicalyceal aberration:uniformity in heterogeneity[J].J Endourol,2009,23(4):609-614.
[13]Rodrigues PL,Rodrigues NF,Fonseca J,et al.Kidney targeting and puncturing during percutaneous nephrolithotomy:recent advances and future perspectives[J].J Endourol,2013,27(7):826-834.
[14]Roy OP,Angle JF,Jenkins AD,et al.Cone beam computed tomography for percutaneous nephrolithotomy:initial evaluation of a new technology[J].J Endourol,2012,26(7):814-818.