持续肾盂灌注对兔肾损伤的实验研究

Experimental study on the effect of constant pressure pelvic flushing on renal function

目的研究兔单侧肾盂恒压灌注后对肾脏的影响。方法对50只家兔行单侧输尿管造瘘，灌注组输尿管造瘘后立即行灌注，假手术组只造瘘不灌注，灌注压力分别为60、80、100、120cmH2O，术后每天留取尿标本定量测定尿三蛋白：即免疫球蛋白（IgG）、白蛋白（AIB）、β2微球蛋白（β2-MG），连续取肾组织行病理检查监测兔肾形态学改变。结果所有灌注兔肾术后都出现尿蛋白增高，术后第1天与术前相比，都有显著性差异（P〈0．01），灌注各组术后第1天与假手术组相比，也有显著性差异（P〈0．01），术后第1天在灌注各组间有显著性差异（P〈0．01）；灌注后第6天后各种蛋白趋于正常，与假手术组无显著性差异，但β2-MG恢复时间稍长，80cmH2O以上压力灌注后术后第6天所测结果与假手术组相比仍有显著性差异（P〈0．05）；形态学表现：肉眼观：灌注后即刻见肾盂内充满灌注液，肾脏颜色逐渐变深，包膜紧张，肾脏较前增大，压力越高改变越明显，且随着压力增高，部分肾脏包膜下有少量渗出，在压力超过100cmH2O时，19例中有16例出现明显的水外渗。术后再次取病理时见肾脏大小、颜色无明显改变。显微镜下观察见集合系统扩张，并随着压力的增高，改变更明显，恢复时间越长。结论压力为60～120cmH2O对兔肾盂进行灌注时，在短期内会出现尿三蛋白及组织学改变，提示短暂的肾功能损害，且压力越高，肾功能损害越严重，恢复时间越长，但只要引流通畅，避免感染，肾功能则会较快恢复。

Objective To study the effect of flushing the pelvis with normal saline at constant pressure on renal function to provide a theoretical basis of pathogenesis of renal injury during endoscopic procedures. Method Fifty rabbits underwent tube as a method of urinary diversion, the flushing group perfused immediately after ureterocutaneostomy, and the intrapelvic pressure is 60, 80, 100, 120cmH2O, but the sham-operated group didn＇t flush. Urinary protein excretion were examined every day after operation,we also got pathological examination of nephridial tissue continually. The urinary protein include immunoglobulin G, microalbuminuria and β2-microglobulin- Result All the flushed rabbits had the change of urinary protein, the difference of urinary protein was of statistical significance between the before and the first day after treatment（P〈0. 01 ）, they are also have statistical significance between sham-operated group and the other groups in the first day（P〈0. 01）, statistic the differences of urinary protein in the first day after treatment between groups have prominent significance（P〈0. 01）. They have. no statistical significance in the sixth day after operation, but the β2-mieroglobulin has excetion- The histomorphometry showed that renal parenchyma swelling, pyelocaliectasis, effusion of the renal infra-capsule, edema of the renal sinus, they are sixteen in nineteen have majority of effusion. Renal pelvis and calyoes dilatationthe, theinflammatory cells corrosion and cast by microscope. The more of the tense, the more obviously of the dilation of pelvis and calyoes, and the longer time of functional recovery. Conclusion When we flushed the pelvis at 60-120cmH2O, we could see the momently change of the urinary and histomorphy, the higher of tense, the more of renal function were damaged, and the longer time of functional recovery. If only they have no obstruction, free from infection, the renal function should soon get as usual.