微创经皮肾镜取石术对肾血流动力学的影响

目的探讨微创经皮肾镜取石术（MPCNL）穿刺通道数量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74例单侧肾结石患者MPCNL术前及术后1个月肾脏血流动力学变化,对比分析单通道取石（57例）、双通道取石（10例）患者及多通道取石（7例）3组肾内肾辛动脉、段间动脉、叶间动脉收缩期间峰值流速（Vmax）及收缩期峰值流速（S）与舒张期末流速（D）的比值（S／D）和阻力指数（resistant index,RI）。结果术前、术后1个月3组肾主动脉Vmax、S／D、R1值比较,差异均无统计学意义（P值均〉0．05）;3组肾段间动脉Vmax、S／D、R1值比较,单、双通道取石组P值均〉0．05,多通道取石组P值均〈0．05,术后肾内血流较术前明显减少;3组肾叶间动脉Vmax、S／D、RI值比较,P值均〈0．05,单通道、双通道MPCNL术后肾内血流动力学指标明显改善,多通道MPXNL术后肾内血流较术前明显减少。结论单通道、双通道MPCNL能明显改善术后肾脏血流灌注,多通道MPCNL对术后肾脏血流灌注有不利影响。

Effect of minimally invasive percutaneous nephrolithotomy on the renal hemodynamics

Objective To study the hemodynamics change of kidney after single tract, double tracts or multiple tracts minimally invasive percutaneous nephrolithotomy(MPCNL). Methods A retrospectively clinical study was performed on 74 patients of renal calculi after MPCNL. The hemodynamics measurements of kidney were monitored by color Doppler ultrasorograph before MPCNL and one month after MPCNL. The peak flow-rate in systole Vmax (cm/s), the ratio(S/D) of the peak flow-rate in systole(S) of the flow-rate at the end of diastole(D) ,and the resistant index(RI) of the chief renal arteries and intersegmental arteries and interlobar arteries were analyzed. Results By comparison of Vmax,S/D and RI of intersegmenlal arteries before MPCNL and after MPCNL, there was no significant difference between single tract and double tracts MPCNL (P>0. 05), while multiple tracts MPCNL showed less (P<0. 05). The comparison of Vmax. S/D and RI of interlobar arteries before and after MPCNL, all 3 groups were significantly differen(P<0. 05). Conclusions The renal hemodynamics are less influenced by single tract and double tracts MPCNL than by multiple tracts MPCNL.