肾窦内肾盂加肾后下部切开取石术对肾血流动力学的影响

The effect of incision of the intrarenal sinus plus postrenal low pole segmental incision for removal of calculus on the renal hemodynamics

目的 探讨肾窦内肾盂加肾后下部切开取石术对肾内血流动力学的影响。 方法 应用彩色多普勒血流显像连续观察 98例复杂性肾结石患者术前及术后 1、3、6个月肾内及切口区域血流动力学变化 ,对比分析肾内主肾动脉、段间动脉、叶间动脉收缩期峰值流速 (S)与舒张期末流速 (D)的比值 (S/D)和阻力指数 (RI) ,并将区域血流信号分为Ⅰ～Ⅳ级观察。 结果 肾内血流动力学变化与肾积水程度相关 (P <0 .0 5 ,r =0 .82 ) ,手术对肾内血流动力学指标影响不明显 (P >0 .0 5 ) ,但对切口区域则造成短期局限性血流障碍 ,多表现为Ⅲ～Ⅳ级血流信号 ,一般 3～ 6个月后逐渐恢复 ,恢复时间长短与结石合并肾积水程度相关。 结论 肾窦内肾盂加肾后下部切开取石术是治疗复杂性肾结石的一种安全有效的方法。

Objective To evaluate the effect of incision of the intrarenal sinus plus postrenal low pole segmental incision for removal of calculus on the renal hemodynamics. Methods The hemodynamic changes of intrarenal and incisional sites in 98 cases with complex calculi were consecutively monitored by color Doppler ultrasonograph before operation and also 1 month,3 months,6 months after operation.The ratio(S/D) of the peak flow-rate in systole(S),the flow-rate at the end of diastole(D),and the resistant index(RI) of the intrarenal chief renal arteries and intersegmental arteries and interlobar arteries were analyzed.The signals of blood stream in segmental incision were divided into four classes(Ⅰ to Ⅳ) and were observed. Results The changes of the intrarenal hemodynamics were related to the degrees of hydronephrosis(P<0.05,r=0.82).The operation had little effect on the intrarenal hemodynamics(P>0.05),but it caused the blood stream to be obstructed in the area of incision where the signals of blood stream showed classes Ⅲ to Ⅳ.The patients generally recovered after 3 to 6 months,and the time of recovery was associated with the degrees of hydronephrosis Conclusions It is concluded that the incision of the intrarenal sinus plus postrenal low pole segmental incision for removal of calculus is an effective and safe method for treat-ment of complex renal calculus.