肾门解剖结构的极大变异性：指导手术入路的放射解剖学图谱
Extreme Variability of the Kidney Hilar Architecture: A Radioanatomical Map to Guide Surgical Approaches.
摘要(中文译文)
腹膜后手术通道，尤其是在机器人辅助肾部分切除术和供体手术中，需要精确掌握肾门血管的走行方向。通常所述的静脉-动脉-肾盂（Vein-Artery-Pelvis，VAP）解剖结构常被默认存在，但其可靠性缺乏充分的量化评估。因此，本研究旨在提供全面的肾门结构放射解剖图谱，以提高手术安全性和可预测性。研究评估了200例患者（104例男性、96例女性）的腹部增强计算机断层扫描（CT）图像。记录肾门结构由前至后的排列顺序、早期血管分支的发生频率以及副血管的存在情况，并按性别和侧别进行分层分析。传统VAP顺序仅见于少数病例，占32.6%（131侧）。图谱共识别出37种不同的排列变异型。最常见的变异型包括VAPA（9.0%）、AVAP（7.8%）和VAAP（7.0%）。男性对典型VAP解剖结构的符合率（27.9%）显著低于女性（37.7%）。以早期分支或副血管为特征的动脉复杂性见于43.2%的侧别，且在男性和右侧的发生率显著更高。静脉图谱显示出明显的侧别差异；副静脉主要见于右侧（12.5%），而早期静脉分支主要见于左侧（30.0%）。肾门结构表现出显著的变异性，经典VAP构型仅占少数。这些发现强调了术前个体化影像评估的重要性，并有助于预判腹膜后手术中的解剖复杂性。
Abstract
Retroperitoneal surgical corridors, particularly in robotic-assisted partial nephrectomy and donor surgery, require precise knowledge of hilar vascular orientation. The typically described Vein-Artery-Pelvis (VAP) anatomy is often assumed, yet its reliability is poorly quantified. Therefore, the purpose of the present study is to provide a comprehensive radioanatomical map of hilar architecture to enhance surgical safety and predictability. Contrast-enhanced computed tomography (CT) scans of the abdomen from 200 patients (104 males and 96 females) were evaluated. The anterior-to-posterior sequence of hilar structures, the frequency of early vascular branching, and the presence of accessory vessels were documented and stratified by sex and laterality. The conventional VAP sequence was observed in a minority of cases, occurring in only 32.6% (131 sides). The map identified 37 distinct sequence variants. The most common variants included VAPA (9.0%), AVAP (7.8%), and VAAP (7.0%). Adherence to typical VAP anatomy was significantly lower in males (27.9%) than in females (37.7%). Arterial complexity, characterized by early branching or accessory vessels, was present in 43.2% of sides, with a significantly higher occurrence in males and on the right side. Venous mapping revealed a marked lateral disparity; accessory veins were predominantly right-sided (12.5%), whereas early venous branching was predominantly a left-sided feature (30.0%). Renal hilar architecture demonstrates substantial variability, with the classical VAP configuration representing a minority arrangement. These findings highlight the importance of individualized preoperative imaging assessment and may help anticipate anatomical complexity in retroperitoneal surgery.
如何引用
AMA
Daniel Gondorf, George Triantafyllou, Ioannis Paschopoulos, Nikolaos-Achilleas Arkoudis, Georgios Velonakis, Panagiotis Kokoropoulos, et al. Extreme Variability of the Kidney Hilar Architecture: A Radioanatomical Map to Guide Surgical Approaches.. Diagnostics (Basel, Switzerland). 2026; doi:10.3390/diagnostics16101544.
APA
Daniel Gondorf, George Triantafyllou, Ioannis Paschopoulos, Nikolaos-Achilleas Arkoudis, Georgios Velonakis, Panagiotis Kokoropoulos, et al (2026). Extreme Variability of the Kidney Hilar Architecture: A Radioanatomical Map to Guide Surgical Approaches.. Diagnostics (Basel, Switzerland). https://doi.org/10.3390/diagnostics16101544
GB/T 7714
Daniel Gondorf, George Triantafyllou, Ioannis Paschopoulos, Nikolaos-Achilleas Arkoudis, Georgios Velonakis, Panagiotis Kokoropoulos, et al. Extreme Variability of the Kidney Hilar Architecture: A Radioanatomical Map to Guide Surgical Approaches.[J]. Diagnostics (Basel, Switzerland), 2026 doi:10.3390/diagnostics16101544.
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