不同穿刺路径经皮肾通道与肾脏血管损伤的关系

Relationship between the establishment of percutaneous renal access and injury of the renal blood vessels using different puncture pathways in an animal model

目的比较不同穿刺路径下建立不同大小皮肾通道的肾脏血管损伤情况。方法2018年4月至2019年6月选取80个新鲜猪肾,分别经正常肾锥体中心线(路径A)、融合肾锥体一侧锥体的中心线(路径B)、融合肾锥体正中线(路径C)和肾柱正中线(路径D)4种路径穿刺,每条穿刺路径均分别建立F8、F12、F16、F20、F24和F30共6种不同大小的通道,依据穿刺路径及通道大小共设置24个实验组。采用病理组织学方法比较相同大小通道下4种穿刺路径的血管损伤情况,以及相同穿刺路径下不同大小通道的血管损伤情况。结果经路径A和路径B穿刺以损伤皮质层Ⅴ、Ⅵ级动脉为主。经路径C穿刺,通道内可见白色结缔组织包绕的血管显露,总体以损伤Ⅳ级动脉为主。经路径D穿刺,通道内血管密布,Ⅲ~Ⅵ级动脉均损伤严重。经路径A、B、C、D分别扩张至F30、F24、F16、F12时出现Ⅲ级动脉损伤。4种不同穿刺路径的总体动脉损伤程度在F8(χ^2=8.259,P=0.041)、F12(χ^2=12.610,P=0.006)、F16(χ^2=15.386,P=0.002)、F20(χ^2=16.288,P=0.001)、F24(χ^2=16.068,P=0.001)和F30(χ^2=10.298,P=0.016)通道的差异均有统计学意义。路径A和D相比,F12(P=0.045)、F16(P=0.025)、F20(P=0.015)、F24(P=0.007)和F30(P=0.043)通道差异有统计学意义;路径A和C相比,F16(P=0.048)、F20(P=0.046)和F24(P=0.037)通道差异有统计学意义;路径A和B相比,6种通道差异均无统计学意义(P>0.05)。经路径A穿刺时,F8与F30通道相比差异有统计学意义(P=0.038);经路径B穿刺时,F8与F24(P=0.046)、F30(P=0.027)通道相比差异有统计学意义。结论经肾柱正中线穿刺建立皮肾通道的血管损伤最严重,其次为经融合肾锥体正中线,经融合肾锥体一侧锥体的中心线和正常肾锥体中心线穿刺的血管损伤相对较少。经融合肾锥体一侧锥体的中心线、正常肾锥体中心线分别扩张至F24、F30通道时血管损伤增加。

Objective To compare the injury of renal blood vessels using different puncture pathways and access sizes.Methods Between April 2018 and June 2019,eighty fresh pig kidneys were selected to perform percutaneous puncture and dilation,which was used to compare the injury of renal blood vessels with different puncture pathways and access sizes.The puncture pathway included the centerline of the normal renal pyramid(A),centreline of one side pyramid of the fused renal pyramid(FRP)(B),midline of the entire FRP(C)and midline of the renal column(D).The access size included F8,F12,F16,F20,F24 and F30.Histopathological methods were used to analyze the injury of renal blood vessels.Results The puncture through paths A and B mainly caused injury to the grade Ⅴ and Ⅵ arteries in renal cortex.The puncture often directly injures the grade Ⅳ artery in path C.The puncture often simultaneously injures the grade Ⅲ-Ⅵ arteries in path D.Grade Ⅲ artery injury began to occur when paths A,B,C,and D were dilated to F30,F24,F16,and F12,respectively.The degree of arterial injury among the four different puncture pathways was significantly different in F8,F12,F16,F20,F24 and F30(P<0.05).Statistical differences were found between paths A and D in F12,F16,F20,F24 and F30(P<0.05),and between paths A and C in F16,F20 and F24(P<0.05).No significant difference was found between paths A and B in all access sizes(P>0.05).Compared with F8,the degree of arterial injury of the F30 in path A and the F24 and F30 in path B were increased significantly(P<0.05).Conclusions Vascular injury in path D was the most serious followed by that in path C.Relatively little vascular injury can be achieved in paths A and B.The vascular injury increased when the path B was dilated to F24,while the path A needed to be dilated to F30.