彩色多普勒超声对经皮肾镜超声弹道气压碎石术前后积水肾脏血流灌注变化评估价值

Evaluation of Changes of Renal Blood Flow in Hydronephrosis Ridney before and after Percutaneous Nephrolithotripsy with Pneumatic and Ultrasonic Lithotripsy Using Color Doppler Flow Imaging

目的探讨彩色多普勒超声(CDFI)评估经皮肾镜超声弹道气压碎石术前后积水肾脏血流灌注变化的价值。方法选取河北联合大学附属医院2009年12月—2011年10月行经皮肾镜超声弹道气压碎石术的合并积水的肾结石患者49例,使用Philips IU-22型彩色多普勒超声仪,观察患者经皮肾镜超声弹道气压碎石术前后各级肾动脉血流指标。结果经皮肾镜超声弹道气压碎石术前和术后肾主动脉(MRA)近心端、MRA远心端、肾段动脉(SRA)、肾叶间动脉(IRA)均全部显示;术后肾弓状动脉(ARA)显示率(95.9%)较术前高(77.6%),差异有统计学意义(χ2=7.184,P=0.007)。术前与术后MRA近心端收缩期峰值流速(PSV)、舒张末期流速(EDV)、阻力指数(RI),MRA远心端PSV、EDV,IRA RI,ARA EDV比较,差异均无统计学意义(P>0.05);术后较术前MRA远心端RI降低,SRA PSV、EDV升高,SRA RI降低,IRA PSV、EDV升高,ARA PSV、RI升高,差异均有统计学意义(P<0.05)。结论 CDFI为评价经皮肾镜超声弹道气压碎石术对积水肾脏肾内血流灌注改善的敏感指标,为制定临床治疗方案,评价治疗效果,预测疾病转归提供科学的方法,具有很好的临床应用前景。

Objective To evaluate the changes of renal blood flow in hydronephrosis kidney before and after pereuta- neous nephrolithotripsy with pneumatic and ultrasonic lithotripsy by color Doppler flow imaging （CDFI） . Methods Forty - nine patients with kidney stone and hydronephrosis who underwent percutaneous nephrolithotripsy with pneumatic and ultrasonic litho- tripsy in Hebei United University Affiliated Hosptial between Dec 2009 and Oct 2011 were collected. Preoperative and postopera- tive renal artery Hemodynamies Index were analyzed retrospectively with Philips IU -22 ultrasonic diagnostic device. Results The proximal and distal ends of main renal artery （ MRA）, segmental renal artery （SRA） and intedobar renal artery （IRA） be- fore and after pereutaneous nephrolithotripsy with pneumatic and ultrasonic lithotripsy were all displayed; The display rate （95.9%） of postoperative areuate renal artery （ARA） was significantly higher than that （77.6%） of preoperative A RA （X2 = 7. 184, P = 0. 007 ） . No statistical differences were found in peak systolic velocity （PSV） and end -diastolic velocity （EDV） and resistent index （RI） of proximal ends of MRA before and after surgery （ P 〉 0. 05 ）, preoperative and postoperative PSV, EDV, IRA RI and ARA EDV of distal ends of MRA were not significantly different （ P 〉 0. 05 ） ; After surgery, the value of RI of distal ends of MRA and SRA dropped distinctly, PSV and EDV of SRA and IRA increased, PSV and RI of ARA increased （ P 〈 0. 05 ） . Conclusion CDFI is asensitive index of renal blood flow in hydronephrosis kidney for assessing percutaneous nephro- lithotripsy with pneumatic and ultrasonic lithotripsy, and is a scientific method to evaluate therapeutic efficacy and predict disease outcome.