摘要
目的 探讨上尿路梗阻解除后患侧肾功能的恢复情况.方法 回顾性分析2015年1-12月我们收治的78例上尿路梗阻患者的临床资料,男42例,女36例.年龄21 ～ 68岁,平均（51.3±12.8）岁.确诊为上尿路狭窄6例,上尿路结石72例.所有患者术前均行CT和发射型计算机断层扫描（emission computed tomography,ECT）检查.根据术前患肾肾小球滤过率（glomemlarfiltration rate,GFR）将患者分为中度组（GFR≥15.0 ml/min）43例,GFR均值为（23.1±5.0）ml/min,术前肾皮质厚度均值为（12.5 ±4.3）mm;重度组（7.5 ml/min≤GFR＜ 15.0 ml/min）23例,GFR均值为（11.2±2.3） ml/min,术前肾皮质厚度均值为（8.3±3.7）mm;极重度组（GFR＜7.5 ml/min） 12例,GFR均值为（4.3 ±2.9） ml/min.对78例患者分别采用输尿管镜碎石取石术、经皮肾造瘘术、经皮肾镜取石术、输尿管软镜碎石取石术等术式解除梗阻.术后1个月复查患肾ECT检查,比较各组患者的患肾功能恢复情况,对手术前后GFR及恢复差值与术前肾皮质厚度做直线相关性分析.对极重度组,术后随访时间延长至8～12个月.结果 解除梗阻后,中度组患肾GFR均值为（30.6±8.5） ml/min,平均恢复（7.6±7.6）ml/min;重度组患肾GFR均值为（13.1±4.5）ml/min,平均恢复（1.9±3.4）ml/min.两组数据与术前比较差异均有统计学意义（均P＜0.05）,中度组术后GFR恢复差值大于重度组,差异有统计学意义（P＜0.05）.极重度组术后1个月GFR均值为（11.1±3.4） ml/min,平均恢复（6.8±4.8）ml/min;术后8～12个月GFR均值为（12.7±3.6） ml/min,与术前比较差异均有统计学意义（均P＜0.05）.患肾术前、术后GFR以及GFR恢复差值与术前肾皮质厚度呈非完全线性正相关（P＜0.05）,术前相关系数（0.59）低于术后相关系数（0.70）,差异有统计学意义（P＜0.05）.结论 上尿路梗阻解除后大部分患肾功能能够得到不同程度的恢复;梗阻影响术前ECT检查对患肾实际功能测定的准确性;部分术前评估认为可切除的肾脏,解除梗阻后GFR能够恢复至可予保留的水平.
Objective To investigate the recovery of affected side kidney function after upper urinary tract obstruction was relieved Methods 78 patients who had been diagnosed with upper urinary tract obstruction were enrolled from January to December of 2015 in our hospital.All patients received the surgery to relieve the obstruction.GFR of the affected side kidney was done after one months of the surgery.The average age was（51.3 ± 12.8）years old.The reason of obstruction was upper urinary tract calculi （72 cases） and upper urinary tract stenosis （6 cases） respectively.All the patients received CT and ECT before and after operation.All the patients was divided into 3 groups by the decreased degree of affected side kidney function,including moderately decreased group [15 rnl/min ≤ GFR 〈 30 ml/min,n =43,mean value =（23.1 ±5.0） mL/min],severely decreased group [7.5 rnL/min≤ GFR 〈 15 ml/min,n =23,mean value =（11.2 ± 2.3） ml/min],and extreme severely decreased group [GFR 〈 7.5 ml/min,n =12,mean value =（4.3 ± 2.9）ml/min].Linear correlation analysis was used to analysis the relationship analysis between the GFR value （pre-operation,post-operation） and the renal cortical thickness.The follow up time of extreme severely decreased group extended to 8-12 months.Results The GFR of moderate decreased group recovered to（30.6 ± 8.5） ml/min,regained averagely （7.56 ± 7.62） ml/min;the severely decreased group recovered to （13.1 ± 4.5） ml/min,regain （1.94 ± 3.38） ml/min.Extreme severely decreased group recovered to （11.1 ± 3.4） ml/min,regained averagely （6.75 ± 4.76） rnl/min,the GFR mean value after operation 8-12 months recovered to （12.7 ± 3.6） ml/min.All groups got significant recovery of kidney function of the affected side.The correlation coefficient between GFR value and the renal cortical thickness was 0.59 （before the surgery） and 0.70 （after the surgery） respectively （P 〈 0.05）.Conclusions Most of affected side kidneys got different degree of recovery.Obstruction influenced the accuracy of ECT at the time of evaluating the actual renal function before operation.The kidneys which had been supposed should be resected in presurgical evaluation could recover to the level of kidney reserve after the surgery.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2017年第3期170-173,共4页
Chinese Journal of Urology
关键词
上尿路梗阻
肾功能
恢复
保留
Upper urinary tract obstruction
Renal function
Recovery
Retain
