气腹压对不同程度积水肾的损伤作用

Kidney Injury Caused by Pneumoperitoneum Pressure in Various Degrees of Kidney Hydronephrosis

目的:研究不同大小的气腹压力对于不同程度的积水肾的损伤作用。方法:采用输尿管套扎法建立左侧轻、重度肾积水模型,54只新西兰大白兔随机分为三组:假手术组(N组,n=18),轻度积水组(M组,n=18),重度积水组(S组,n=18),每组再分为三个亚组,依次给予0,10,15mmHg气腹加压处理1h。术后48h取左侧肾脏,HE染色观察肾小管形态结构,测肾组织内活性氧(ROS),丙二醛(MDA),乳酸(LD)含量,TUNEL检测细胞凋亡,取血清检测血肌酐(Cr),尿素氮(BUN)。结果:对于假手术组和轻度积水组,当压力为15mmHg时,肾损伤明显加重(肾小管结构明显改变,凋亡指数明显增加,ROS,MDA,LD含量明显升高);对于重度积水组,当压力为10mmHg时,肾脏损伤即明显加重。各小组Cr及BUN的差异无统计学意义。结论:重度积水的肾脏更容易受到气腹压造成的进一步损伤,行腹腔镜手术时应适当控制气腹压的大小。

Objective： To clarify acute kidney injury caused by pneumoperitoneum pressure in various degrees of unilateral kidney hydronephrosis. Methods. A total 54 rabbits were randomly allocated to three groups（group N, M and S,i. e. rabbits with no,mild and serve hydronephrosis, respectively） ,18 rabbits for each group, the hydronephrosis models were induced by embeding left ureters into psoas. All groups were then allocated to 3 subgroups. Then, they were subjected to intraabdominal pressures of 0, 10, and 15 mmHg, respectively, lasting for 1 hour. After 48 hours, all kidneys were harvested, and the kidney injury was assessed by measuring serum creatinine （Scr）, blood urea nitrogen （BUN）, levels of reactive oxygen （ROS） , malondialdehyde （MDA） and lactic acid（LD）in renal parenchyma, renal pathological ehanges（H＆E staining）, tuber cell apoptosis. Results. Kidney injury was obviously exacerbated （with high ROS,MDA,LD,increased tubular cell apoptosis and renal pathological changes）when intraabdominal pressure reached 15 mmHg in N and M groups. In S group,these changes were found when the pressure was only 10 mm-Hg. No significant changes of Scr and BUN levels were found in all these groups. Conclusion： Kidneys with serve hydronephrosis were more likely to suffer kidney injuries when exposed to pneumoperitoneum pressure. So, intraabdominal pressure should be controlled appropriately in laparoscopy operations with hydronephrosis.