标准经皮肾镜取石术对结石并肾积水患者早期肾血流的影响!  

Effect of standard percutaneous nephrolithotripsy on renal hemodynamics of patients with upper urinary stone and hydronephrosis

作　　者：李许睿[1] 李文刚[2] 陈伯成[3] 周大庆[2] 禹岳华[4] 王坚[2] 刘尚文[2] 何猛[2] 庞翔[2] 江波[2] 余小祥[2] 

机构地区：[1]上海交通大学医学院附属九院临床医学院,上海200125 [2]解放军303医院泌尿外科,广西南宁530021 [3]解放军303医院麻醉科,广西南宁530021 [4]解放军303医院超声科,广西南宁530021

出　　处：《现代泌尿外科杂志》2014年第11期712-715,共4页Journal of Modern Urology

基　　金：广西自然科学基金资助项目(No.2011GXNFA018277);广西卫生厅科自筹基金项目(No.Z2011010)

摘　　要：目的探讨标准经皮肾镜取石术对上尿路结石合并肾积水患者肾血管阻力指数的影响。方法 60例单侧上尿路结石并对侧肾功能正常患者按患肾积水程度分为轻度(15例)、中度(32例)、重度(13例)。采用标准通道超声联合气压弹道经皮肾镜碎石,其中单通道52例、双通道8例。应用彩色多普勒血流显像测定术前24h和术后0、48、120h双肾肾血管阻力指数。比较手术前后各组肾血管阻力指数的差异。结果经皮肾镜取石术术后各组患侧肾脏肾血管阻力指数即刻升高,并维持至术后48h,与术前比较有显著性统计学差异(P<0.01),术后5d恢复至术前水平(P>0.05);各组健侧肾脏术后肾血管阻力指数变化特点与患肾相同。结论标准经皮肾镜取石术可造成早期双肾血流降低,而双肾血流改变与术前肾积水程度无关。Objective To evaluate the effect of standard percutaneous nephrolithotripsy （PCNL） on the renal resistance index （RI） of patients with upper urinary stone and hydronephrosis .Methods A total of 60 patients with unilateral upper u‐rinary stones and normal contralateral kidneys were divided into 3 groups according to the severity of hydronephrosis ：mild （group 1 ,15 cases） ,moderate （group 2 ,32 cases） ,high grade （group 3 ,13 cases） .All patients received standard PCNL with EMS Ⅲ ：52 patients with single tract and 8 patients with two tracts .Intrarenal RI of obstructed and normal contralateral kid‐neys were measured 24 h before operation and 0 h ,48 h ,and 120 h after operation .All data were analyzed by multilevel model with a mixture of response types using SPSS11 .0 .Results After PCNL ,the values of intrarenal RI of obstructed kidneys rose immediately and remained high until 48h after PCNL （P〈0 .01 compared to preoperation） .They returned to the level of pre‐PCNL at 120h after PCNL （P〉0 .05 compared to preoperation） .After PCNL ,the changes of intrarenal RI of normal contra‐lateral kidneys were similar to those of obstructed kidneys .Conclusions PCNL may lead to early decrease of blood flow in both kidneys ,which doesn＇t relate to the severity of hydronephrosis .

关 键 词：肾血管阻力指数 经皮肾镜取石术 上尿路结石 肾积水 

分 类 号：R692.4[医药卫生—泌尿科学]