彩色多普勒超声对肾积水不显影的肾功能评估及其意义

Color Doppler ultrasonography for the evaluation of renal function of hydronephrotic kidney with no image on intravenous urography and its significance

目的探讨彩色多普勒超声对一侧梗阻性肾积水不显影肾脏的肾功能评估价值。方法收集48例因一侧梗阻性肾积水IVU不显影患者,应用彩色多普勒超声测定肾内动脉血流阻力指数(R I),并与肾穿刺造瘘24 h引流量比较。结果24 h引流量分别为肾无功能组(110±80)m l(31例)、肾功能改善组(430±50)m l(13例)、肾功能恢复组(720±70)m l(4例),3组间比较差异均有统计学意义(P<0.05)。肾造瘘前肾无功能组、功能改善组和功能恢复组肾内动脉R I分别为0.81±0.01、0.75±0.01、0.65±0.03,肾实质厚度分别为(0.18±0.04)cm、(0.35±0.09)cm、(0.44±0.02)cm;肾造瘘后肾内动脉R I分别为0.76±0.04、0.68±0.02、0.60±0.04,肾实质厚度分别为(0.46±0.04)cm、(0.53±0.01)cm、(0.68±0.03)cm。相关分析显示24 h引流量与R I呈显著相关性(r=0.54,P<0.05)。结论当R I>0.81时,肾功能基本不能恢复。彩色多普勒超声在IVU不显影的积水肾功能评估中有重要临床意义。

Objective To investigate the significance of color Doppler uhrasonographic evaluation of renal function of obstructively hydronephrotic kidney with no image on intravenous urography （IVU）. Methods A total of 48 patients with chronic severely obstructive hydronephrosis that had no image on IVU were enrolled in this study. The thickness of renal parenchyma and intrarenal arterial resistive index （RI） were examined by color Doppler ultrasound before operation. Then the results were compared with the findings of 24-h drainage flow after percutaneous puncture and pathological examination. Results According to drainage flow, the patients were divided into 3 groups, ie, non-functional, functional improvement and functional recovery groups. The parameters determined in these 3 groups were sequentially as follows：24-h drainage flow was （110 ±80） ml, （430 ±50） ml, （720 ±70） ml,respectively （P 〈0.01） ; before percutaneous puncture the RI was （0.81 ± 0.01 ）, （0.75 ± 0.01 ）, （0.65 ± 0.03） ,and the renal parenchyma thickness was （ 0. 18 ± 0.04 ） cm, （ 0.35 ± 0.09 ） cm, （ 0.44 ± 0.02 ） cm, respectively ; after percutaneous puncture the RI was （0.76 ± 0.04）, （0.68 ± 0.02 ）, （0.60 ± 0.04 ）, and the renal parenchyma thickness was （ 0.46 ± 0.04 ） cm, （0.53 ± 0.01 ） cm, （ 0.68 ± 0.03 ） cm, respectively. Correlation analysis showed that 24-h drainage flow was significantly associated with RI （P 〈 0.05）. Conclusions It is suggested that when RI 〉 0.81 ,the probability of recovery was less in renal function of diseased kidney. Color Doppler ultra-sonography has an important role in evaluation of renal function of hydronephrotic kidney with no image on IVU.