肾盂灌注冲洗对肾脏功能和结构的影响  

Effects of renal pelvis infusion on renal function and structure

作　　者：丁军[1] 陈仙[1] 杨帆[1] 邱伟彬[1] 张彪[1] 罗志刚[1] 

机构地区：[1]南华大学第二附属医院,湖南衡阳421001

出　　处：《现代生物医学进展》2011年第5期850-853,共4页Progress in Modern Biomedicine

基　　金：湖南省科技厅科研基金课题(2008FJ3221)

摘　　要：目的:探讨经皮肾镜碎石术肾盂灌注冲洗压对肾脏结构和功能的影响。方法:建立20头活体猪高压肾盂冲洗模型,建立24F肾造瘘通道,分别在0mmHg(作自身对照,只造瘘不灌注)、150mmHg、200mmHg、250mmHg、300mmHg压力下各冲洗30分钟。术中取肾组织送病理检查,监测肾单位光镜和电镜下的形态学改变;术后5天留取尿标本,应用免疫比浊测定法(ITM)检测尿微量白蛋白(ALB)和β2-微球蛋白(β2-MG);并于术后第5天再次取肾组织行病理检查观察肾单位的形态学改变。结果:所有灌注组术后都出现尿蛋白的增高,术后第1天和术前相比,都有显著差异(P<0.01)。形态学观察:当肾盂灌注冲洗压在150-200mmHg时,光镜下观察见肾小囊腔轻度扩张,压力超过250mmHg,肾小囊腔见红细胞和蛋白渗出物,肾小管扩张。电镜下见肾近曲小管上皮细胞内空泡形成,微绒毛排列杂乱、稀疏、部分微绒毛脱落。结论:肾盂灌注冲洗安全压不应超过200mmHg。Objective：To explore the influence of kidney＇s structure and function of intrapelvic perfusion under percutaneous nephrolithotripsy（PCNL）.Methods：High-pressure intrapelvic perfusion model was established under different pressure for twenty swines,to establish 24F nephrostomy established channels,in 0 mmHg（for self-control,only ostomy not perfusion）,150mmHg,200mmHg,250mmHg,300mmHg pressure for 30 minutes intrapelvic perfusion respectively.The renal biopsy specimens were used to pathologic examination and were taken for observed the morphological changes under light and electron microscopy during an operation;The urine samples were collected and applied Immune than turbidity method detection of urinary albumin（ALB） and β2-microglobulin（β2-MG）;after operation for 5 days;and the 5 day after operation,renal specimens were taken for observed the renal pathology and renal unit of the morphological changes again.Result：All the Infusion group had the change of urinary protein,the difference of model was of statistical significance between the before and the first day after treatment（P0.01）.Morphological observation：When we flushed the pressure at 150-200mmHg,we could see the slight expansion of renal cysts in light microscope.When the pressure over 250mmHg,there are red blood cells and protein exudations in renal cysts as well as the tubular dilation in the same area.There are vacuolizations,microvillus arranged in cluttered and sparse,some microvillus was shaded in electron microscopy.Conclusion：The ideal intrapelvic perfusion for PNL was lower than 200mmHg.

关 键 词：肾盂灌注 压力 肾单位 损伤 

分 类 号：R692.4[医药卫生—泌尿科学]