^(99m)Tc-双半胱氨酸利尿肾动态显像在肾盂输尿管结合部狭窄患者手术前后肾功能评估中的价值

Value of ^(99m)Tc-ethylenedicysteine Diuretic Dynamic Renal Imaging in the Evaluation of Renal Function Before and After Operation in Patients with Ureteropelvic Junction Stenosis

目的:探讨^(99m)Tc-双半胱氨酸(EC)利尿肾动态显像(DR)在肾盂输尿管结合部狭窄患者手术前和术后肾功能评估中的临床价值。方法:回顾性分析32例经手术治疗的肾盂输尿管结合部狭窄患者的利尿肾动态显像及随访资料。肾盂输尿管结合部狭窄患者的DR(常规方第15 min注射呋塞米),对患肾血流灌注率(BPR)、动态显像图、肾盂积水分度、有效肾血浆流量(ERPF)、肾曲线进行手术前后的比较。结果:(1)32只患肾的BPR术前为(33.26±9.35)%,术后为(39.68±8.69)%,平均提高6.42%(t=-5.07,P<0.01);患肾的ERPF术前为(62.53±21.32),术后为(76.35±7.58)mL·min^(-1),平均提高13.82 mL·min^(-1)(t=-4.27,P<0.01)。(2)随着积水程度的加重,患肾形态增大,肾实质变薄,肾内放射性缺损范围增大,对利尿试验的反应明显减弱直至无反应。(3)32只患肾的肾盂积水分度的平均秩和术前为37.76,术后为27.03,两者差异有统计学意义(Z=-2.58,P<0.01)。结论:DR是评价肾盂输尿管结合部狭窄患者的一种可靠方法,能够准确反映病情、指导治疗,并监测手术疗效。

Objective： To evaluate the clinical value of 99mTc-ethylenedicysteine diuretic renogra in the evaluation of renal function before and after operation in patients with ureteropelvic junction stenosis.Methods： The diuretic renal dynamic imaging and follow-up data of 32 patients with ureteropelvic junction stenosis treated by surgery were retrospectively analyzed.The DR of patients with Ureteropelvic junction stenosis（fifteenth minutes of conventional injection of furosemide）,the rate of renal blood perfusion（BPR）,dynamic imaging,degree of hydronephrosis,effective renal plasma flow（ERPF）,and renal curve were compared before and after operation.Results：（1） BPR of 32 renals with disease was（33.26 ±9.35） % before operation and（39.68 ± 8.69） % after operation,with an average increase of 6.42%（t =-5.07,P 〈0.01）; ERPF of renals with disease at pre-operative was（62.53 ± 21.32）; post-operative was（76.35 ± 7.58） mL ·min-1 with an average increase of 13.82 mL·min-1（t =-4.27,P 〈 0.01）.（2） With the aggravating of hydronephrosis,the enlarging of diseased kidney,the thinning of renal parenchyma,the increasing range of intrarenal radioactivity defect,the response to the diuretic test significantly diminished until no response.（3） The mean renal hydronephrosis grade in 32 renal with disease was 37.76 preoperatively and 27.03 postoperatively,with significant difference between the two groups（Z =-2.58,P 〈 0.01）.Conclusion： DR is a reliable method for the evaluation of patients with ureteropelvic junction stenosis.It can accurately reflect the patient’s condition,guide treatment,and monitor the effect of operation.