输尿管软镜碎石术围手术期肾彩色多普勒超声血流动力学评价

Evaluation of renal hemodynamics by color Doppler ultrasound during perioperative period of flexible ureteroscopic lithotripsy

目的 彩用彩色多普勒超声(CDFI)对单发肾结石患者输尿管软镜碎石术围手术期肾血流动力学的评价。方法 分析2016年7月至2018年6月共61例输尿管软镜碎石手术的单发肾结石患者,应用CDFI观察围手术期术侧肾叶间动脉血流参数,记录术前1 d、术后1 h内及术后5 d叶间动脉血流参数,并进行统计学分析。结果 围手术期肾叶间动脉血流参数整体分析,收缩期峰值流速(Vmax)、舒张末期流速(Vmin)及阻力指数(RI)数值差异分别具有统计学意义(P<0.05)。与术前血流参数相比,术后1h叶间动脉Vmax及Vmin均减低,RI增高(P<0.017),术后5 d复查,Vmax及Vmin较术后1 h升高、RI较术后1 h减低(P<0.017),与术前测值相比差异无统计学意义(P>0.017)。结论 CDFI可以观察并量化输尿管软镜碎石术围手术期肾内动脉灌注,快速评价术侧肾血流动力学变化,手术后会出现短期、可逆性肾叶间动脉流速减低、RI增高。

Objective To evaluate renal hemodynamics in patients with single renal calculi during perioperative period of flexible ureteroscopic lithotripsy by color Doppler flow imaging(CDFI).Methods The hemodynamic of renal interlobar arteries of 61 patients with one renal calculi who underwent unilateral flexible ureteroscope lithotripsy from Jul.2016 to Jun.2018 were examined separately prior to surgery(Day 1)and after surgery(1 hour and Day 5)by CDFI.Parameters were analyzed statistically.Results There were significant differences in systolic flow(Vmax),diastolic flow(Vmin)and resistance index(RI)during perioperative period(P<0.05).1 h after operation,a statistically significant decrease of Vmax and Vmin,and increase of RI of renal interlobar arterial were found compared with preoperative measurements(P<0.017).In the follow-up of 5 d after operation,Vmax and Vmin were higher than 1 h after operation,and RI was lower than 1 h after operation(P<0.017).There was no significant difference between preoperative measurements and 5 d after operation(P>0.017).Conclusions CDFI can be used to quantify the blood perfusion in kidney after flexible ureteroscope lithotripsy.Renal Vmax and Vmin decreasing and RI increasing can be found in a short timeframe during perioperative period,and the changes are reversible.