行标准通道经皮肾镜碎石清石术患者肾内血流动力学变化的临床观察

Clinical research on renal hemodynamic changes of patients treated with percutaneous nephrolithotripsy through standard channel

目的探讨标准通道经皮肾镜碎石清石术(PCNL)对患者肾血流动力学的近远期影响。方法选取行标准通道经皮肾镜碎石清石术的43例患者,采用彩色多普勒超声对其各级肾动脉的血流参数进行评估,并于术后1d、1周、1个月进行复查,统计分析其手术前后的血流动力学变化规律。结果术后1d,患者肾主动脉、段间动脉、叶间动脉及小叶间动脉的收缩期最高流速(PSV)、舒张期最低流速(EDV)及平均血流速度(Vm)较术前显著降低(P<0.05);阻力指数(RI)较术前显著升高(P<0.05)。术后1周,患者各级肾动脉的PSV、EDV及Vm有所回升,RI有所下降,基本恢复至术前水平(P>0.05);术后1个月,患者各级肾动脉的PSV、EDV及Vm显著高于术前水平(P<0.05),RI显著低于术前水平(P<0.05)。结论基于微创标准通道PCNL术对肾脏血流灌注有短暂的抑制效应;然而,随着术后时间的延长和血运障碍的缓解,患者各项血流动力学参数均可得到有效改善。

ObjectiveTo explore the short and longterm impact of percutaneous nephrolithotripsy （PCNL） through standard channel on renal hemodynamic changes. Methods A total of 43 patients to be treated with standard channel PCNL were selected and evaluated in renal hemodynamic levels with color Doppler ultrasound, and all patients were rechecked one day, one week, and one month after surgery to evaluate the hemodynamic changes. Results One day after operation, the levels of peak systolic velocity （PSV）, end diastolic velocity （EDV）, and mean blood flow velocity （Vm） of the renal aorta, intersegment artery, and interlobar artery significantly decreased while the resistance index （RI） significantly increased （P＜0.05）. One week after operation, the levels of PSV, EDV, and Vm of the renal aorta, intersegment artery, and interlobar artery all increased while RI declined and even returned to preoperative level （P＞0.05）. One month after operation, the levels of PSV, EDV and Vm were significantly above the preoperative levels （P＜0.05） while RI was significantly below the preoperative level （P＜0.05）. Conclusions Standard channel PCNL has transient inhibitory effect on kidney perfusion because of iatrogenic injury. However, all hemodynamic parameters can be improved effectively as postoperative blood supply obstacles are relieved with time.