超声引导下经皮肾一步扩张法与多步扩张法扩张筋膜对猪肾脏损伤的比较  

Comparison of ultrasound-guided percutaneous fascia dilatation with one-step and multi-step percutaneous renal dilatation on renal injury in pigs

作　　者：段依恋 郭鑫亮 余铖[1] 张雯[1] 姚梦云[1] 项飞翔[1] Duan Yilian;Guo Xinliang;Yu Cheng;Zhang Wen;Yao Mengyun;Xiang Feixiang(Department of Ultrasound Medicine,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Clinical Research Center for Medical Imaging in Hubei Province,Hubei Province Key Laboratory of Molecular Imaging,Wuhan 430022,China;Department of Urology,Hubei Hospital of Traditional Chinese Medicine,Wuhan 430000,China)

机构地区：[1]华中科技大学同济医学院附属协和医院超声医学科,湖北省影像医学临床医学研究中心,分子影像湖北省重点实验室,武汉430022 [2]湖北省中医院泌尿外科,武汉430000

出　　处：《中国医师杂志》2022年第9期1285-1289,共5页Journal of Chinese Physician

基　　金：国家自然科学基金(82001852)。

摘　　要：目的评估和比较超声引导下经皮肾一步扩张法与多步扩张法扩张筋膜对实验猪肾脏的损伤。方法取20只实验猪,随机分为16F组和24F组,每组10只。16F组每只实验猪左、右侧肾分别在超声引导下用16F扩张器行经皮肾多步扩张法与一步扩张法(分别为多步法亚组及一步法亚组)扩张筋膜,24F组则用24F扩张器行相同操作。术后左、右侧肾脏均留置造瘘管1周,观察和比较肾造瘘管内肉眼血尿持续时间,1个月后将实验猪处死并摘除肾脏,肉眼和显微镜下观察各组组织病理学,切除肾造瘘通道周围瘢痕组织,分别行HE和Massion染色,应用数字图像分析技术测量瘢痕体积,并计算该瘢痕体积占肾皮质体积的百分率。结果经皮肾16F组一步法亚组和多步法亚组肉眼血尿持续时间分别为(4.60±1.26)d、(4.70±1.17)d,差异无统计学意义(P>0.05);24F组一步法亚组和多步法亚组肉眼血尿持续时间分别为(5.40±1.25)d、(5.50±1.08)d,差异无统计学意义(P>0.05)。16F组和24F组实验猪肾脏标本肉眼和组织学观察无明显差异。16F组一步法亚组和多步法亚组造瘘通道的瘢痕体积[(0.35±0.04)cm^(3)、(0.36±0.03)cm^(3)]及其占整个肾皮质体积的百分率[(0.41±0.05)%、(0.41±0.06)%]比较差异均无统计学意义(均P>0.05);24F组一步法亚组和多步法亚组造瘘通道的瘢痕体积[(0.48±0.02)cm^(3)、(0.49±0.04)cm^(3)]及其占整个肾皮质体积的百分率[(0.52±0.04)%、(0.53±0.07)%]比较差异亦均无统计学意义(均P>0.05)。24F组一步法亚组和多步法亚组的瘢痕体积、瘢痕体积占整个肾皮质体积的百分率均高于16F组,差异有统计学意义(均P<0.05)。结论经皮肾一步扩张法与多步扩张法对肾实质的损伤均较小,多步扩张法在减少肾实质损伤方面较一步扩张法并无明显优势。Objective To evaluate the renal injury of ultrasound-guided percutaneous fascia dilatation with one-step and multi-step percutaneous renal dilatation on renal injury in pigs.Methods 20 experimental pigs were randomly divided into 16F group and 24F group,with 10 pigs in each group.Under the guidance of ultrasound,the left and right kidneys of each experimental pig in group 16F were expanded by percutaneous renal multi-step expansion and one-step expansion(multi-step dilation subgroup and one-step dilation subgroup respectively)with 16F expander,and the same operation was performed with 24F expander in 24F group.After the operation,the left and right kidneys were left with fistula tubes for 1 week.The duration of hematuria in the renal fistula tubes was observed and compared.One month later,the experimental pigs were killed and the kidneys were removed.The histopathology of each group was observed under the naked eye and microscope.The scar tissue around the nephrostomy channel was removed,and hematoxylin-eosin(HE)and Masson staining were performed respectively.The scar volume was measured by digital image analysis technology,and the percentage of the scar volume in the renal cortex volume was calculated.Results There was no significant difference in gross hematuria duration between one-step dilation subgroup[(4.60±1.26)d]versus multi-step dilation subgroup[(4.70±1.17)d]of 16F group(P>0.05);There was no significant difference in gross hematuria duration between one-step dilation subgroup[(5.40±1.25)d]versus multi-step dilation subgroup[(5.50±1.08)d]of the 24F group(P>0.05).There was no significant difference in the gross and histological observation of pig kidney specimens in 16F group and 24F group.There was no significant difference in the scar volume of the fistula channel[(0.35±0.04)cm^(3),(0.36±0.03)cm^(3)]and its percentage in the whole renal cortical volume[(0.41±0.05)%,(0.41±0.06)%]between one-step dilation subgroup versus multi-step dilation subgroup of 16F group(all P>0.05);there was no significan

关 键 词：超声检查 肾造口术 经皮 手术中并发症 肾损伤 

分 类 号：R692[医药卫生—泌尿科学] R445.1[医药卫生—外科学]