超声引导下经皮肾造瘘术对肾积水患肾功能改善的评价

Evaluation of renal function improvement after ultrasound-guided percutaneous nephrostomy for hydronephrosis

目的探讨超声引导下经皮肾造瘘术治疗肾积水的效果及其评价患肾功能的临床价值。方法对26例肾积水患者(30枚患肾)行超声引导经皮穿刺肾造瘘术,超声测量患肾治疗前后肾叶间动脉血流阻力指数和肾实质厚度,术后1周每天记录24 h引流尿量,根据术后患肾24 h引流尿量分为改善组(22枚)和无功能组(8枚),对比分析两组术前、术后肾实质厚度和叶间肾动脉血流阻力指数(RI)。结果术前改善组肾实质厚度为(1.91±0.46)cm,无功能组肾实质厚度为(1.09±0.20)cm,差异有统计学意义(P<0.01);术前改善组叶间肾动脉血流RI为0.67±0.07,无功能组叶间肾动脉血流RI为0.80±0.02,差异有统计学意义(P<0.01)。术后改善组和无功能组患肾叶间肾动脉血流RI均较术前显著降低,肾实质厚度均较术前显著增厚,差异均有统计学意义(均P<0.01)。结论超声引导下经皮穿刺肾造瘘术能准确评估和有效改善肾积水患肾功能,具有较高的临床应用价值。

Objective To explore the effect of ultrasound-guided percutaneous nephrostomy on hydronephrosis and the cilinical value in assessing renal function.Methods Twenty-six cases（30 kidneys） of hydronephrosis underwent ultrasound-guided percutaneous nephrostomy（PCN）.Ultrasonic measurement of renal vascular resistance index（RI）of the interlobar artery and renal parenchymal thickness were performed before and after PCN treatment,and urine output was recorded for a week after PCN.The patients were divided into the functional improved group（22 kidneys）and the nonfunctional group（8 kidneys）according to the daily urine output.The renal parenchymal thickness and RI of interlobar artery were compared between the groups before and after the operation.Results The preoperative renal parenchyma thickness of the functional improved group was（1.91±0.46）cm,while（1.09±0.20）cm in nonfunctional group,there was statistically difference between the groups（P〈0.01）.The preoperative interlobar artery RI of the functional improved group was 0.67±0.07,while 0.80±0.02 in nonfunctional group,there was statistically difference between the groups（P〈0.01）.The interlobar artery RI of the two groups was significantly reduced after PCN（P〈0.01）.The thickness of the renal parenchyma was also significantly thickened after PCN（P〈0.01）.Conclusion PCN can accurately assess and effectively improve the renal function,which has a certain clinical application value.