单侧上尿路梗阻解除前后肾皮质厚度与肾小球滤过率的关系

Relationship between preoperative renal cortical thickness and glomerular filtration rate before and after minimally invasive surgery in patients with unilateral upper urinary tract obstruction

目的探讨单侧上尿路梗阻解除前后肾皮质厚度(RCT)与肾小球滤过率(GFR)的关系。方法选取2015年7月-2016年6月该院泌尿外科收治的63例上泌尿道梗阻患者为研究对象。其中,男34例,女29例,年龄22~73(52.21±11.56)岁;手术方式:输尿管镜碎石+取石术24例,一期经皮肾造瘘+二期经皮肾镜取石术(PCNL)21例,一期PCNL 18例。采用腹部增强CT、单光子发射计算机断层(SPECT)扫描分别测量RCT和GFR,根据术前患肾GFR情况分为3组:A组(中度肾损害,15.0 ml/min≤GFR<30.0 ml/min)、B组(重度肾损害,7.5 ml/min≤GFR<15.0 ml/min)、C组(极重度肾损害,GFR<7.5 ml/min),比较3组的手术前后的GFR变化。采用简单线性相关分析A和B组患者术前RCT与各指标的相关性。结果 9例患者因肾积水严重未测量RCT,患者的术前RCT>10 mm 20例,5~10 mm 23例,<5 mm 11例,平均值为(10.75±4.91)mm。A组术前RCT明显高于B组,差异有统计学意义(P<0.05)。3组患者术后1和9个月的GFR均明显高于同组术前,差异均有统计学意义(P<0.05)。A组术后1和9个月的GFR均明显高于另外两组,B组术后9个月的GFR明显高于C组,差异均有统计学意义(P<0.05),但术后1个月B组和C组的GFR差异无统计学意义(P>0.05)。B组术后1个月的GFR恢复值明显低于另外两组,差异有统计学意义(P<0.05),3组术后9个月的GFR恢复值比较差异无统计学意义(P>0.05)。术前RCT与术前GFR(r=0.613)、术后1个月GFR(r=0.697)及恢复值(r=0.552)、术后9个月GFR(r=0.589)及恢复值(r=0.488)均呈显著正相关,差异有统计学意义(P<0.05)。结论解除上泌尿道梗阻后患者的肾功能得到不同程度的恢复,即使是极重度肾功能损伤者,多数均能挽回患肾。术前RCT能有助于判断围手术期的肾功能,尤其是术后肾功能恢复情况。

Objective To investigate the relationship between preoperative renal cortical thickness and glomerular fltration rate （GFR） before and after minimally invasive surgery in patients with unilateral upper urinary tract obstruction. Methods 63 patients with upper urinary tract obstruction from July 2015 to June 2016 were enrolled in the study, including 34 males and 29 females, age ranged from 22 to 73 years old （52.21 ± 11.56）. Their operation methods included 24 cases of ureteroscopic lithotripsy and lithotomy, 21 cases with one-stage percutaneous nephrostomy ＋ two-stage percutaneous nephrolithotomy （PCNL）, 18 cases of PCNL. The abdominal enhanced CT and single photon emission computed tomography （SPECT） were measured to RCT and GFR. Then all cases were divided into group A （moderate renal impairment, 15.0 ml/min ≤ GFR 〈 30 ml/min）, group B （severe renal damage, 7.5 ml/min ≤ GFR 〈15.0 ml/min） and group C （extremely severe renal injury, GFR 〈 7.5 ml/min） according to preoperative renal GFR, and changes of GFR before and after surgery were compared among three groups. Simple linear correlation analysis was used to analyze the correlation between preoperative RCT and other indexes in group A and B. Results 9 patients were not measured RCT because of serious hydronephrosis, 54 patients included 20 cases of RCT 〉10 mm, 23 cases of 5 ~？7 mm and 11 cases of 〈5 mm, and the average value was （10.75 ± 4.91） mm. The preoperative RCT in group A was signifcantly higher than that in group B （P 〈 0.05）. GFR at 1 and 9 months after operation in three groups were signifcantly higher than that before operation in the same group （P 〈 0.05）. GFR at 1 and 9 months after operation in group A were signifcantly higher than that the other two groups, and GFR at 9 months after operation in group B was signifcantly higher than that in group C （P 〈 0.05）, but there were no signifcant differences in GFR at 1 month after operation between group B and C （P 〉 0.05）. GFR recovery value at 1 month after operation in group B was signifcantly lower than that in other two groups （P 〈 0.05）, but there were no signifcant differences in GFR at 9 months after operation among three groups （P 〉 0.05）. Preoperative RCT was positively correlated with preoperative GFR （r = 0.613）, GFR at 1 month after operation （r = 0.697） and the recovery value （r = 0.552）, GFR at 9 months after operation （（r = 0.589） and recovery values （r = 0.488）, and the differences were statistically signifcant （P 〈 0.05）. Conclusion Removal of upper urinary tract obstruction could recover the renal function to varying degrees, even for patients with extremely severe renal injury, who could retrieve their kidney. Preoperative RCT could be helpful in judging the renal function during operation, especially for the postoperative recovery of renal function.