单侧输尿管梗阻解除后肾功能早期恢复的临床研究

Clinical Study of Early Recovery of Renal Function after Releasing of Unilateral Ureteral Obstruction

目的 研究人类单侧输尿管急慢性梗阻解除后肾功能早期恢复的规律及影响因素。方法 本试验以99mTc DT PA为示踪剂 ,采用SPECT技术分别测定 2 1例患者输尿管梗阻前及解除梗阻后 2 1～ 35d肾小球滤过率 (GFR)、肾图、肾扫描等指标。结果 急性单侧梗阻组解除梗阻 2 1～ 2 8d时 ,患肾GFR增加 11%～ 18% ,基本接近正常 (P <0 .0 1)。慢性单侧梗阻组解除梗阻后 2 8～ 35d时 ,患肾GFR下降约 0 7%～ 4.1% (P <0 .0 5 )。结论 急性单侧输尿管完全梗阻时间小于 7～ 10d ,在解除梗阻后 2 1～ 2 8d时 ,GFR的恢复是完全的。而慢性单侧输尿管不全梗阻时间大于 12周 ,则在解除梗阻后 2 8～ 35d时 ,GFR有轻度下降 ,说明纠正梗阻后梗阻侧肾损害不能逆转而且继续发展。

Objective We study the regular rule of early recovery of renal function after releasing of unilateral ureteral obstruction in human Methods Renal function of 21 patients were detected by single photon emission computerized tomography(SPECT)with tracer agent 99m technetium diethylenetriaminepentaacetic acid( 99m Tc DTPA)before and after releasing of unilateral ureteral obstruction Result 10 patients with unilateral ureteral complete obstruction for 7 to 10 days showed a 11 to 18 per cent return of GFR at the time of ureteral releasing of 21～28 days duration ( P <0.01), basically normal In 11 patients with unilateral ureteral partial obstruction for long time(more than 12 weeks), there was a slight decrease of 0.7 to 1.4 per cent of GFR at the time of releasing obstruction of 28 to 35 days duration ( P <0.05) Conclusion There is almost complete return of GFR in acute obstruction group after releasing obstruction of 21 to 28 days duration, while there was a decrease of GFR in chronic partial obstruction group after releasing obstruction of 28 to 35 days duration