标准通道PCNL对肾脏血流动力学的影响

Effect of Standard Percutaneous Nephrolithotomy on the Renal Hemodynamics

目的:探讨标准通道经皮肾镜碎石清石术(PCNL)对肾内血流动力学影响。方法:应用彩色多普勒血流显像测量100例采用标准通道经皮肾镜碎石清石术患者术前、术后即时、术后1周、术后3个月肾脏主动脉、段间动脉、叶间动脉收缩期峰值流速(V_(max))及收缩期峰值(S)与舒张期末流速(D)的比值(S/D)和阻力指数(resistant index,RI)。结果:术后即时的肾主动脉、段间动脉、叶间动脉的V_(max)、S/D、RI值与术前比较,均P<0.05,差异有统计学意义;但术后1周的肾主动脉、段间动脉、叶间动脉的V_(max)、S/D、RI值与术前比较,均P<0.05;并且术后3个月的肾主动脉、段间动脉、叶间动脉的RI值与术前比较,均P<0.05。结论:标准通道经皮肾镜碎石清石术对肾脏血流灌注有短暂影响,但术后1周左右可以恢复,术后3个月肾脏血流灌注有所改善。

Objective： To discuss the effect of standard percutaneous nephrolithotomy on the renal hemodynamics. Methods：One hundred patients with renal calculi were treated by color ultrasound guided standard percutaneous nephrolithotomy from August 2007 to December 2009. The peak flow-rate in systole Vmax （cm/s）,the ratio（S/D）of the peak flow rate in systole（S）of the flow rate at the end of diastole（D）,and the resistant index（RI）of the chief renal arteries and intersegmental arteries and interlobar arteries were measured by color Doppler flow imaging at four different time point： before PCNI, after PCNL, one week after PCNL and three months after PCNI.. Results：By comparison of Vmax ,S/D and RI of chief renal arteries and intersegmental arteries and interlobar arteries ,there was significant difference between before PCNL and after PCNL（P〈0.05）. But there was no significant difference between before PCNL and after one week（P〉0.05）. And between before PCNL and three months after PCNL, there was significant difference （P〈 0.05）. Conclusions：Color ultrasound guided standard percutaneous nephrolithotomy can reduce renal blood flow for the moment. But one week after PCNL, renal blood flow can revert to the situation of reoperation. And renal blood flow was improved three months after PCNL.