离断式肾盂成形术治疗肾盂输尿管连接部狭窄16例

目的:探讨肾盂输尿管连接部狭窄(uretero pelvic junction obstruction,UPJO)的手术治疗方法。方法:采用Anderson-Hynes离断式肾盂成形术治疗UPJO16例。结果:16例手术均获成功,肾盂积水好转,狭窄解除,吻合口通畅。随访6个月,未出现吻合口再狭窄、肾积水加重等并发症。结论:Anderson-Hynes离断式肾盂成形术是治疗UPJO的首选术式。     

后腹腔镜肾盂成形术与开放手术比较

目的比较后腹腔镜与开放手术肾盂成形术的疗效,探讨后腹腔镜术式的技术要点。方法 37例肾盂输尿管连接部梗阻患者,其中20例行后腹腔镜下肾盂成形术,17例行开放性肾盂成形手术,后腹腔镜术式采用气管插管全身麻醉,开放途径采用全身麻醉或腰硬联合麻醉。两组术中均行离断性肾盂成形术及留置双J管。结果 后腹腔镜组手术时间(181±42.8)m in长于开放组(130.2±37.4)m in(P<0.05),术中出血量80(50~200)m l少于开放组150(120~400)m l(P<0.05),术后止痛药(曲马朵)用量(60±7)mg、术后住院时间(8.6±5.1)d、腰部感觉异常5%优于开放组(260±9)mg、(14.2±10.4)d、70.6%(P<0.01)。后腹腔镜组术后尿漏(1例与1例)、肾盂输尿管连接部再狭窄(1例与0例)及肾积水改善与开放手术组比较无统计学意义(P>0.05)。结论后腹腔镜肾盂成形术疗效令人满意。其临床价值可与开放途径相比,并且具有出血少,术后疼痛轻、恢复快等优点,掌握一定的技巧后能使手术时间缩短,可代替开放手术在临床应用。     

双J管在离断式肾盂成形术治疗肾盂输尿管连接部梗阻中的应用

目的探讨离断式肾盂成形术治疗肾盂输尿管连接部梗阻及使用双J管的经验和体会。方法2006年9月－2010年3月对68例先天性。肾盂输尿管连接部梗阻引起的肾积水患儿应用Aderson—Hynes离断式肾盂成形术治疗,术中均放置双J管作支架和引流。结果68例术后7d出院,65例术后1—2个月经尿道膀胱镜顺利完整取出双J管,3例提前取出。随访3—36个月,复查B超及静脉肾盂造影（IVU）显示,患肾形态有缩小,肾实质厚度增加,造影检查时见吻合口以远输尿管显影,排泄通畅。结论离断式肾盂成形术治疗先天性肾盂输尿管连接部梗阻,术中放置双J管作支架和引流,临床效果确切。     

改良离断性肾盂成形术治疗肾盂输尿管连接处狭窄的体会

目的 探讨改良离断性肾盂成形术对肾盂输尿管连接处狭窄的治疗效果.方法 采用改良离断性肾盂成形术,对26例先天性肾盂输尿管连接处狭窄患者彻底切除连接处狭窄.结果 随访0.5～3年,24 例治愈,狭窄解除,吻合口通畅,肾盂积水消失.2例发生再狭窄,再次行狭窄段切除并吻合后治愈.结论 改良离断性肾盂成形术是治疗肾盂输尿管连接处狭窄的有效方法,彻底切除肾盂输尿管连接处狭窄,保证吻合口通畅及局部低压状态,是防止术后再狭窄或梗阻的关键.     

IVP后CT扫描诊断小儿肾盂输尿管连接部梗阻

目的：探讨ＩＶＰ／ＣＴ 诊断小儿ＵＰＪ 梗阻的价值。材料与方法：ＩＶＰ 显示重度肾盂积水迹象,或６０ ｍｉｎ 后肾内收集系统不显影、影像极淡者立即行ＣＴ 连续扫描,计２６ 例。结果：肾盂、肾盏明显囊状扩张,腔内呈水样密度（５ 例） 、形成液体界面（１２ 例） ,肾实质表现为肾盏周围环形或弧形持续增强的高密度影（１７ 例） ,肾盂、肾盏扩张程度较轻并充盈造影剂（９ 例） ,无输尿管扩张征象。此为本病的特征性表现。结论：诊断小儿ＵＰＪ 梗阻显示病肾形态学具有特征性的继发改变,ＩＶＰ／ＣＴ 是一种快速而准确的方法。     

肾移植受者术前甘油三酯代谢对移植肾早期功能恢复的影响

目的 探讨肾移植受者术前甘油三酯(TG)代谢对其移植肾早期功能(EGF)恢复的影响.方法 回顾性分析2011年1月-2014年12月170例在解放军309医院接受活体肾移植受者的临床资料,经排除标准筛选后最终纳入154例受者,其中男124例,女30例,年龄31.9±8.4岁.根据受者术前TG水平分为TG正常组(0.40＜TG≤1.70mmol/L,n=107)及TG异常组(TG＞l.70mmol/L或需服用降脂药控制血脂者,n=47),观察两组患者中移植肾功能恢复不佳(PEGF)、肾功能延迟恢复(DGF)和肾功能缓慢恢复(SGF)的发生率,进一步比较移植肾功能顺利恢复(IGF)的两组受者术后3、7及30d的肌酐(Scr)水平.绘制以TG为诊断指标的ROC曲线,以获得预测肾移植术后发生PEGF、SGF、DGF风险的最佳TG值.结果 与TG正常组相比,TG异常组的受者术后PEGF及DGF的发病率较高,差异有统计学意义(P＜0.05).IGF的受者中,TG异常组术后7、30d的Scr值高于TG正常组,差异有统计学意义(P＜0.05).术前TG预测PEGF、SGF及DGF的ROC曲线下面积(AUC)分别为0.774、0.704、0.818,均明显大于机会参考下面积(P＜0.05),最佳临界值均为1.37mmol/L.结论 受者术前TG代谢异常对移植肾早期功能恢复可能具有负性影响.术前受者TG在正常高值时(＞1.37mmol/L),其发生PEGF、SGF和DGF的风险便已增加.     

肾移植术后受者血清中肝肾功能指标动态监测的临床意义

 目的 探讨肾移植术后受者肝、肾功能各指标的动态变化及其临床意义。方法 应用日立7600生化全自动分析仪对受者术后1、3、5、7 d,1、2、3周血清中的肝肾功能指标进行动态监测,比较肾功能恢复稳定组(A组)与肾功能恢复不良组(B组)各指标的差异。结果 (1) B组术后1 d 尿素氮(BUN)水平高于A组(P＜0.05),A组在5 d后持续下降,B组在2周内下降,3周反弹时水平约为A组的两倍(P<0.01);(2)术后1 d B组肌酐(CR)水平约为A组1.5倍,A组呈递减趋势;B组水平出现反弹,3周时B组水平约为A组的3倍(P<0.01);(3)两组术后胱抑素C(CYSC) 水平在1 d时无统计学差异,A组呈下降趋势,B组在3 d后出现持续反弹,到3周时超过术后1 d的水平,约为A组的2.5倍(P<0.01);(4)两组转氨酶水平均在正常参考范围内,同组谷草转氨酶(AST)、谷丙转氨酶(ALT)变化极其相似,A组总胆汁酸(TBA)呈缓慢上升趋势,B组的改变无规律;(5)超敏C反应蛋白(HS-CRP)3周内两组水平无统计学差异(P>0.05)。结论 为正确评估受者肾功能,建议以CYSC替代BUN、CR,联合检测受者血清中TBA、CRP更能全面地反映肝功能的状态。     

右美托咪啶对活体亲属供肾者术后肾功能的影响

 目的 探讨右美托咪啶对活体亲属供肾者术后肾功能的影响。方法 选择2015-01至2017-12择期亲属供肾术者40例,随机分为右美托咪啶组和对照组,各20例。右美托咪啶组供肾者麻醉诱导前10~15 min静脉泵入右美托咪啶1 μg/kg,继以0.5 μg/(kg·h)维持,手术结束前30 min停药;对照组供肾者按右美托咪啶组静脉泵入等量的生理盐水。于麻醉诱导前(T₁)、术毕即刻(T₂)、术后24 h(T₃)、术后48 h(T₄)采血检测TNFα、IL-6和IL-10的浓度。监测术前、术后24 h及48 h血清尿素氮(BUN)及肌酐(Cr)浓度。结果 右美托咪啶组较对照组术后24 h和48 h血清BUN[24 h, (6.41±1.23) mmol/L vs (9.24±1.25) mmol/L; 48 h, (6.62±1.30) mmol/L vs (8.41±2.4) mmol/L]和Cr[24 h, (98.2±4.7) μmol/L vs (111.4±5.1) μmol/L; 48 h, (104.4±6.2) μmol/L vs (119.5±8.2) μmol/L]明显降低(P<0.05)。T₂-T₄时右美托咪啶组与对照组比较,血清TNF-α和IL-6浓度均明显降低,而IL-10的浓度明显增高(P<0.05)。结论 一定剂量的右美托咪啶对活体亲属供肾者手术后早期具有肾功能保护作用。     

Estimation of renal function in patients with chronic kidney disease

The risk of nephrogenic systemic fibrosis after gadolinium exposure is inversely related to renal function. Various methods are available to assess the glomerular filtration rate (GFR). Prediction formulas based on serum creatinine, such as the abbreviated Modification of Diet in Renal Disease (MDRD) formula, are most commonly used and appear acceptable for clinical purposes in the majority of patients with chronic renal failure. However, especially in patients at the extremes of body composition, the results from creatinine‐based equations should be interpreted with caution. In those patients, additional methods, such as timed urine collections, predictions based on cystatin, single‐shot radiotracer methods, or, optimally, inulin clearance could be considered. In this review, the strengths and limitations of different methods to assess GFR are discussed. Apart from inulin clearance, no method can be considered the gold standard in the assessment of GFR. In cases of doubt, the decision to use gadolinium‐enhanced magnetic resonance imaging should always be based on clinical risk–benefit judgment. J. Magn. Reson. Imaging 2009;30:1341–1346. © 2009 Wiley‐Liss, Inc.     

核素肾动态显像对急性上尿路梗阻肾功能修复的实验研究

目的:探讨放射性核素肾动态显像与上尿路梗阻后肾功能恢复的相关性。方法:我们建立了狗和大白兔的上尿路梗阻动物模型,并应用放射性核素显像、光镜技术观察和检测梗阻不同时期肾脏的功能和病理改变及梗阻解除后的肾功能恢复情况。结果:梗阻8～10d的实验动物,解除梗阻2周后,肾功能基本恢复。梗阻4～6周的实验动物,解除梗阻4月后,肾功能可恢复到轻-中度损伤程度。梗阻7～8周的实验动物,解除梗阻4月后,肾功能无法恢复。结论:放射性核素显像是评价肾功能修复的重要技术手段,可作为外科判断梗阻后肾切除与否的可靠指标。     

慢性肾功能不全病人血透前后血清一氧化氮的变化

目的 为研究慢性肾功能不全(CRF)病人血液透析治疗前后血清一氧化氮(NO)的变化及其与肾功能和血压的关系。方法 观察了用硝酸还原法测定的27例病人血透前后血清NO浓度的变化,并与尿素氮(BUN)、肌酐(Cr)和平均动脉压(MAP)进行了比较。结果 血透后病人肾功能明显改善,但NO和MAP无显著性改变。NO与BUN、Cr、MAP均无相关。结论 说明CRF病人内环境改变复杂,血压受多种因素影响,NO仅在其中起一小部作用;血透对NO无即时的影响。CRF病人体内NO的改变及其意义尚需进一步研究。     

血液透析对老年肾衰竭患者心脏结构及功能的影响

 目的 探讨血液透析对老年肾衰竭患者心脏结构和功能的影响.方法 36例老年肾衰竭患者,回顾分析其透析前和透析治疗3个月后的左心室舒张末期内径(LVDd)、左心室收缩末期内径(LVDs)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、短轴缩短分数(FS)和射血分数(EF)等超声心动图资料,并进行对照分析.结果 老年肾衰竭患者透析治疗3个月后,LVDd、LVDs和左室肥厚的发生较透析前无明显变化(P>0.05),但FS(20.63±9.51 vs 26.59±11.80)和EF(42.27±12.16 vs 56.64±13.10)增加,E/A(1.72±0.29 vs 0.87±0.31)降低.结论 血液透析治疗可改善老年肾衰竭患者的心脏功能.     

Salivary function in patients with chronic renal failure undergoing hemodialysis

PURPOSE: The aim of this study was to evaluate the changes in salivary gland function in patients with chronic renal failure (CRF) undergoing hemodialysis. METHODS: The group consisted of 23 patients with CRF (13 female, 10 male; mean age: 40 +/- 13 yr) and 14 healthy control subjects (mean age: 40 +/- 13 yr). All underwent dynamic salivary gland scintigraphy with gustatory stimulation. After intravenous administration of 99mTc pertechnetate, first, perfusion images at 2 seconds per frame were acquired for 1 minute, then dynamic images at 1 minute per frame were acquired for 45 minutes. At 30 minutes after injection, 10 ml lemon juice was given for 15 minutes as a gustatory stimulus. We obtained time-activity curves derived from regions of interest centered over the four major salivary glands. The following functional indices were calculated for each gland: the time of maximum radioactivity (Tmax) for the prestimulated period, the time of minimum radioactivity (Tmin), as an indicator of velocity of secretion after stimulation, and the Lem E5% value as an indicator of the secretion function. RESULTS: When the patients with CRF undergoing hemodialysis were compared to the controls, there were statistically significant differences in Tmax, Tmin and Lem E5% values for bilateral parotid glands, and Tmin values for bilateral submandibular glands (p < 0.05), there were no statistically significant differences in Tmax and Lem E5% values for bilateral submandibular glands. There were also significant differences in Tmax and Lem E5% values for bilateral parotid glands between mild oral problems and severe oral problems in patients with CRF (undergoing hemodialysis). CONCLUSION: In this study, prolonged Tmax and Tmin values, and decreased Lem E5% values for parotid glands and prolonged Tmin values for submandibular glands on salivary scintigraphy pointed out decreased parenchymatous and excretory function in patients with CRF undergoing hemodialysis.     

单侧输尿管梗阻解除后肾功能早期恢复的临床研究

目的　研究人类单侧输尿管急慢性梗阻解除后肾功能早期恢复的规律及影响因素。方法　本试验以99mTc DT PA为示踪剂 ,采用SPECT技术分别测定 2 1例患者输尿管梗阻前及解除梗阻后 2 1～ 35d肾小球滤过率 (GFR)、肾图、肾扫描等指标。结果　急性单侧梗阻组解除梗阻 2 1～ 2 8d时 ,患肾GFR增加 11%～ 18% ,基本接近正常 (P <0 .0 1)。慢性单侧梗阻组解除梗阻后 2 8～ 35d时 ,患肾GFR下降约 0 7%～ 4.1% (P <0 .0 5 )。结论　急性单侧输尿管完全梗阻时间小于 7～ 10d ,在解除梗阻后 2 1～ 2 8d时 ,GFR的恢复是完全的。而慢性单侧输尿管不全梗阻时间大于 12周 ,则在解除梗阻后 2 8～ 35d时 ,GFR有轻度下降 ,说明纠正梗阻后梗阻侧肾损害不能逆转而且继续发展。     

The effect of radiopharmaceutical choice on the assessment of the relative renal function in upper urinary tract obstruction

The relative function of the obstructed kidney (RFOK) was assessed in 43 adult patients with upper urinary tract obstruction (UUTO) using ^99mTc-DTPA and ¹³¹I-ortho-iodohippurate (OIH) dynamic studies and ^99mTc-DMSA dynamic and static studies. The patients were divided into five groups according to the duration and degree of obstruction. Findings were as follows: a) in patients with the first occurrence of acute severe obstruction (group 1), the relative glomerular filtration rate (GFR) was significantly less than the relative effective renal plasma flow (ERPF); b) in patients with chronic severe obstruction and long term uroinfection, the relative ERPF decreased significantly compared with the relative GFR; c) the RFOK calculated from the DMSA dynamic study was the same as both the relative GFR or ERPF in any group; d) the RFOK calculated from the DMSA static study seemed to parallel the relative ERPF more closely than the relative GFR, but in group one it was significantly higher than any of three other estimates. It is concluded that ^99mTc-DTPA is the radiopharmaceutical of choice in obstructive uronephropathy, but when interpreting the RFOK, the time course and severity of obstruction, the presence or absence of uroinfection should also be considered.     

Assessment of the optimal time interval and background region of interest in the measurement of differential renal function in Tc-99m-EC renography

BACKGROUND: Differential renal function (DRF) measurements are routinely corrected for background, which mainly affects the reproducibility and accuracy of the measurement. The present study was conducted to identify the most appropriate background ROI and optimal time interval in the calculation of DRF for EC renography. MATERIALS AND METHODS: Nineteen patients were studied. For determination of DRF in EC renography, the selected time intervals were 0.5-1.5; 0.5-2; 1-2; 1.5-2.5; 2-3 min, and the background ROI types were inferolateral crescent, lateral crescent, and perirenal shaped. The reference DRF was obtained through DMSA study. For low functioning kidney of each patient, relative uptake differences between the DMSA and EC scans were calculated. Then, the mean differences and the standard deviations were found. RESULTS: The highest correlation was between the DRF values obtained using inferolateral background ROI in 0.5-2 minutes of EC scintigraphy and the DRF values obtained through posterior DMSA images (r = 0.9889). However, there were no statistically significant differences between the mean DRF values obtained for each time interval with each ROI type (p > 0.05). For all the time intervals and background ROIs, the mean of the differences was <0.9%. In conclusion, in obtaining comparable DRF values from EC and DMSA studies, none of the background types proved superior. Also our research for optimal time interval showed that EC scintigraphy underestimates the DRF when compared to DRF obtained from DMSA study. The DRF has a tendency to decrease as the later time intervals are used. The time intervals less than 2.5 minutes show lower underestimation of DRF values.     

Rapid estimation of split renal function in kidney donors using software developed for computed tomographic renal volumetry

Purpose

To evaluate the speed and precision of split renal volume (SRV) measurement, which is the ratio of unilateral renal volume to bilateral renal volume, using a newly developed software for computed tomographic (CT) volumetry and to investigate the usefulness of SRV for the estimation of split renal function (SRF) in kidney donors.

Method

Both dynamic CT and renal scintigraphy in 28 adult potential living renal donors were the subjects of this study. We calculated SRV using the newly developed volumetric software built into a PACS viewer (n-SRV), and compared it with SRV calculated using a conventional workstation, ZIOSOFT (z-SRV). The correlation with split renal function (SRF) using ^99mTc-DMSA scintigraphy was also investigated.

Results

The time required for volumetry of bilateral kidneys with the newly developed software (16.7 ± 3.9 s) was significantly shorter than that of the workstation (102.6 ± 38.9 s, p < 0.0001). The results of n-SRV (49.7 ± 4.0%) were highly consistent with those of z-SRV (49.9 ± 3.6%), with a mean discrepancy of 0.12 ± 0.84%. The SRF also agreed well with the n-SRV, with a mean discrepancy of 0.25 ± 1.65%. The dominant side determined by SRF and n-SRV showed agreement in 26 of 28 cases (92.9%).

Conclusion

The newly developed software for CT volumetry was more rapid than the conventional workstation volumetry and just as accurate, and was suggested to be useful for the estimation of SRF and thus the dominant side in kidney donors.     

The effect of renal artery stenting on hypertension and renal function in patients with atherosclerotic renovascular disease

IntroductionAtheroscleroticrenal arterystenosisisassociatedwithhypertension ,progressivelossofrenalfunctionandrecurrentpulmonaryedema [1 3].Althoughsurgicalrevascularizationhasbeenshowntoimprovebloodpressurecontrol,preserveorstabilizerenalfunction [4 ],andreverseend stagerenalfailure[5 ],itsmorbidityandmortalityrateshavebeenhigherthanthoseofstentrevascularization [6 ].Stentrevascularizationhasbeenshowntobesuperiorto“balloononly”angioplastyandsurgicalrevascularization [7].Thisstudyevaluatesth…     

Split renal function in patients with suspected renal artery stenosis: a comparison between gamma camera renography and two methods of measurement with computed tomography

Purpose: To validate a method for calculating split renal function from computed tomography (CT) compared with gamma camera renography, and to test a new method for the measurement based on a volume-rendering technique.

Material and Methods: Thirty-eight patients, aged 65.7±11.6 (range 37.8-82.1) years, who had undergone both CT angiography and gamma camera renography for a suspected renal artery stenosis were included in this study. Split renal function was calculated from the CT examinations by measuring area and mean attenuation in the image slices of the kidneys, and also by measuring volume and mean attenuation from a 3D reconstruction of the kidneys. Gamma camera renography with ^99mTc-MAG3 with or without captopril enhancement was used as a reference.

Results: The 2D CT method had good correlation with renography (r = 0.93). Mean difference was 4.7±3.6 (0-12) percentage points per kidney. There was also excellent correlation between the two CT methods (r = 1.00).

Conclusion: CT is equivalent to renography in determining split renal function, and the measurement from the CT examination can be made more quickly and equally accurately with a 3D technique.     

持续肾盂灌注对兔肾损伤的实验研究

目的研究兔单侧肾盂恒压灌注后对肾脏的影响。方法对50只家兔行单侧输尿管造瘘,灌注组输尿管造瘘后立即行灌注,假手术组只造瘘不灌注,灌注压力分别为60、80、100、120cmH2O,术后每天留取尿标本定量测定尿三蛋白：即免疫球蛋白（IgG）、白蛋白（AIB）、β2微球蛋白（β2-MG）,连续取肾组织行病理检查监测兔肾形态学改变。结果所有灌注兔肾术后都出现尿蛋白增高,术后第1天与术前相比,都有显著性差异（P〈0．01）,灌注各组术后第1天与假手术组相比,也有显著性差异（P〈0．01）,术后第1天在灌注各组间有显著性差异（P〈0．01）;灌注后第6天后各种蛋白趋于正常,与假手术组无显著性差异,但β2-MG恢复时间稍长,80cmH2O以上压力灌注后术后第6天所测结果与假手术组相比仍有显著性差异（P〈0．05）;形态学表现：肉眼观：灌注后即刻见肾盂内充满灌注液,肾脏颜色逐渐变深,包膜紧张,肾脏较前增大,压力越高改变越明显,且随着压力增高,部分肾脏包膜下有少量渗出,在压力超过100cmH2O时,19例中有16例出现明显的水外渗。术后再次取病理时见肾脏大小、颜色无明显改变。显微镜下观察见集合系统扩张,并随着压力的增高,改变更明显,恢复时间越长。结论压力为60～120cmH2O对兔肾盂进行灌注时,在短期内会出现尿三蛋白及组织学改变,提示短暂的肾功能损害,且压力越高,肾功能损害越严重,恢复时间越长,但只要引流通畅,避免感染,肾功能则会较快恢复。