Sampaio F J
Department of Anatomy, State University of Rio de Janeiro, Brazil.
J Urol. 1992 Apr;147(4):999-1005. doi: 10.1016/s0022-5347(17)37445-1.
3-Dimensional endocasts of intrarenal structures were analyzed on the basis of their importance for performing nephron-sparing surgery. In 86.6% of the endocasts the superior pole was related to 3 arteries involved in its resection. Management of the superior (apical) segmental artery as well as ligature of the artery related to the anterior surface of the upper infundibulum are generally not difficult. Ligature of the posterior segmental artery branch related to the superior pole is critical due to the risk of injuring this segmental artery and loss of a great portion of renal parenchyma. In 62.2% of the endocasts the inferior pole resection involved ligature of the inferior segmental artery with no risk to the posterior segmental artery. A deep anatomical knowledge is mandatory to perform mid kidney resection. In 36.4% of the endocasts this region received subdivision branches of arteries from superior and inferior poles, and in 62.2% the mid kidney resection involved amputation of calices that are dependent on polar calices. The middle branch of the posterior segmental artery also is involved in mid kidney resection and its ligature demands much care to avoid injury to the posterior segmental artery itself. In the dorsal kidney the posterior segmental artery is involved and must be safeguarded in all cases of either superior pole or mid kidney resection. In 37.8% of the cases the posterior segmental artery also may be involved in inferior pole resection. When present (69.2%), the retropelvic vein must be previously ligated to provide safe management of the posterior segmental artery.
基于肾保留手术的重要性，对肾内结构的三维铸型进行了分析。在86.6%的铸型中，上极与3条参与其切除的动脉相关。上（尖）段动脉的处理以及上肾盂前表面相关动脉的结扎通常并不困难。由于存在损伤该段动脉和损失大部分肾实质的风险，与上极相关的后段动脉分支的结扎至关重要。在62.2%的铸型中，下极切除涉及下段动脉的结扎，对后段动脉无风险。进行肾中部切除必须具备深厚的解剖学知识。在36.4%的铸型中，该区域接受来自上极和下极的动脉分支，在62.2%的铸型中，肾中部切除涉及切除依赖于极部肾盏的肾盏。后段动脉的中间分支也参与肾中部切除，其结扎需要格外小心以避免损伤后段动脉本身。在肾背侧，后段动脉参与其中，在所有上极或肾中部切除的情况下都必须加以保护。在37.8%的病例中，后段动脉也可能参与下极切除。当存在肾后静脉（69.2%）时，必须预先结扎以确保后段动脉的安全处理。
