移植肾功能稳定受者肾动脉阻力指数的影响因素

目的 探讨移植肾功能稳定受者肾动脉阻力指数（RI）的影响因素。资料与方法 回顾性分析2016年9月—2019年9月于苏州大学附属第一医院就诊的133例移植肾功能稳定受者,根据移植肾动脉RI值分为低RI组（RI<0.7）64例和高RI组（RI≥0.7）69例。收集临床资料（年龄、性别、术后随访时间、肾病病史时长、透析方式及时间、供体年龄、供肾冷缺血时间、热缺血时间等）、实验室检查（血清肌酐并估算肾小球滤过率、总胆固醇、甘油三酯、他克莫司浓度、环孢素A浓度、24 h尿蛋白量等）结果,比较两组间的差异。构建二元Logistic回归模型分析移植肾动脉RI的影响因素。结果 两组移植肾受者年龄（t=3.419）、血清肌酐（t=2.235）、肾小球滤过率（t=2.316）、甘油三酯（t=2.675）比较,差异有统计学意义（P均<0.05）。以RI高、低作为因变量,纳入受者年龄、血清肌酐、肾小球滤过率、总胆固醇、甘油三酯作为自变量进行二元Logistic回归分析,结果显示受者年龄（P=0.002）、血清甘油三酯（P=0.008）纳入模型,年龄增长和血清甘油三酯升高是高RI的危险因素。结论 ...     

微创经皮肾镜取石术中肾盂压力改变对肾形态的影响

目的探讨经微创皮肾镜取石术(MPCNL)中肾盂内压力变化对肾及肾周形态的影响。方法 50例采用MPCNL处理的肾结石患者,术中通过逆行置入的输尿管导管连接尿动力学仪监测肾盂内压力,将压力≥40cmH2O且累计时间≥5min者作为高压组(n=21),其余为低压组(n=29),手术后即刻和术后13、、5d行CT扫描以明确肾及肾周形态变化。结果高压组肾盂压力平均为26.5(13～149)cmH2O,低压组为22.4(11～125)cmH2O。所有患者术后即刻均发现肾周积液,肾实质增厚1.2～4.3mm,与术前相比有统计学差异(P<0.05),术后即刻高压组肾实质厚度为17.4±1.7mm,与低压组(16.2±2.3mm)间有统计学差异(P<0.05),此后积液逐渐吸收,肾实质厚度与术前无统计学差异(P>0.05)。结论 MPCNL时肾盂压力仅有数分钟超过40cmH2O,灌注液的逆流和外渗是MPCNL常见现象,肾盂压力越高其程度越严重,但均可在短时间内吸收。     

彩色多普勒超声评价经皮肾镜超声弹道气压碎石术对肾血流灌注变化的影响

目的运用彩色多普勒超声评价经皮肾镜超声弹道气压碎石术治疗对肾血流灌注变化的影响。资料与方法观察60例经皮肾镜超声弹道气压碎石术治疗的患者肾动脉血流彩色多普勒超声表现,对患者术前、术后各级肾动脉血流参数进行分析。结果术后肾叶间动脉、段动脉收缩期峰值流速(PSV)、舒张末期流速(EDV)高于术前,差异有统计学意义(t=3.570、2.517、3.213、2.957,P<0.05或P<0.01),阻力指数(RI)术前、术后比较差异无统计学意义(t=0.808、1.099,均P>0.05)。肾主动脉远心端、近心端PSV、EDV及肾主动脉近心端RI术前、术后比较差异无统计学意义(t=0.142、1.580、0.123、0.834、0.862,均P>0.05),术后肾主动脉远心端RI低于术前,差异有统计学意义(t=2.197,P<0.05)。结论经皮肾镜超声弹道气压碎石术能有效改善肾内血管的血流灌注。     

经肾造瘘管顺行低压冲洗在输尿管上段结石输尿管硬镜碎石术中的临床应用:附58例报告

目的 总结经肾穿刺造瘘管顺行低压冲洗在逆行输尿管硬镜下处理输尿管上段结石的临床资料,寻找简单、适合基层医院的输尿管上段结石微创手术方法.方法 选择2013年6月-2014年12月在解放军第309医院行输尿管上段结石逆行输尿管硬镜碎石术的患者58例,其中男33例,女25例,年龄平均43.5(22～67)岁,结石长径平均1.25(0.7～1.8)cm.患者先行超声引导下经皮肾穿刺造瘘,术中经肾造瘘管顺行低压冲洗,同时逆行输尿管硬镜下行气压弹道碎石术.因输尿管狭窄无法完成输尿管镜检查者不纳入临床观察.结果 58例患者中54例(93.1％)一期碎石成功.2例(3.4％)伴有明显肉芽组织形成包裹结石,更改为腹腔镜手术.2例(3.4％)部分结石返回肾盂,其中1例留置D-J管后行体外冲击波碎石治疗,另1例结石再次嵌顿二次输尿管硬镜碎石.手术时间平均47(24～70)min.无感染发生,术后2d拔除肾造瘘管,无继发出血.平均住院时间4.5(2～7)d.无发热,无脓肾,无菌血症和败血症的发生,肾造瘘处无继发出血,无漏尿.结论 超声引导下经皮肾穿刺造瘘通过顺行冲洗,使输尿管硬镜下输尿管上段结石气压弹道碎石术安全、有效,结石返回肾盂发生率明显降低,清石率高.该方法顺行、低压冲洗可避免逆行感染,且简单易行,费用低,适合基层医院开展.     

肾动态显像对小儿先天性肾积水手术前后患肾功能的评价

应用＾９９ｍＴｃ－ＤＴＰＡ对１２例小儿单侧先天性肾积水手术前后进行肾动态显像及单肾功能测定，结果患肾功能术后较术前明显提高，且发现术前功能降低越明显者，术后功能相对提高越显著，但部分病例患肾功能仍明显低于正常。     

超声引导在经皮肾镜取石术中的应用价值

目的 探讨超声引导在经皮肾镜取石术中的应用价值.方法 对300例经经皮肾镜碎石取石术治疗的患者的术中超声引导、治疗结果进行了总结分析.结果 所有患者手术通道建立顺利.结论 泌尿系结石患者通过超声实时动态引导穿刺、碎石、取石,可极大地提高取石的准确性,缩短手术时间和减少手术创伤.     

MRI引导下经皮肾造口术：可行性研究

本研究的目的是评价在低场开放型MRI系统中行MRI引导下经皮肾造口术（PCN）的可行性和安全性。这一前瞻性研究包括8例病人。肾集合系统扩张的程度从基本正常到严重不等。所有操作均独立在一可行介入视觉跟踪的0．23T开放性C型臂MR成像系统下完成。每例PCN病人均在配置MR兼容的引流设备下进行Seldinger技术操作。8例中7例成功完成了MRI引导下肾造口术。所有肾集合系统扩张的病例均成功实施了全部PCN治疗过程，     

局麻下二期经皮肾镜取石治疗结石性慢性肾功能不全

目的探讨治疗结石性慢性肾功能不全的有效方法和安全性。方法采用局部浸润麻醉和B超引导下先行一侧或双侧肾穿刺扩张至18F,留置肾造瘘管引流,以后再根据肾功能和贫血情况的改善,行局麻下二期经皮肾镜取石术。共治疗65例,男40例,女25例。结石直径1.2～6.5 cm,平均3.5 cm。术前血肌酐160～2180μmol/L,平均630μmol/L;血红蛋白49～108 g/L,平均89 g/L。结果 65例都采用单通道取石,1次取石28例,2次取石26例,3次取石9例,4次取石2例,结石取净率92%。术后血肌酐119～794μmol/L,平均270μmol（仅有5例血肌酐〉400μmol/L）;血红蛋白68～120 g/L,平均105 g/L。住院15～97 d,平均36 d。治疗期间无需辅以腹透或血透。无术中、术后大出血或中转开放手术,无水中毒。结论局麻下二期经皮肾镜取石治疗结石性慢性肾功能不全,是一种简单、安全、经济、有效的治疗方法,风险小、并发症少,术后经随访多数病人肾功能都得到了不同程度的改善,无需再作透析治疗。     

肾动脉阻力指数预测上尿路梗阻肾功能的临床价值

本文为了解上尿路梗阻肾脏功能的情况，我们应用彩色多普勒显像，根据肾动脉血流频谱，对５２个上尿路梗阻的肾及４０个正常肾，进行肾动脉阻力指数（ＲＩ）计算分析，现分析如下。１资料和方法５２个上尿路梗阻的肾，来自本院住院３６名患者，男１７例，女１８例，平均年...     

经皮肾镜联合输尿管软镜钬激光碎石对复杂性肾结石患者结石清除率及肾功能的影响

目的 研究经皮肾镜联合输尿管软镜引导钬激光碎石治疗复杂性肾结石的效果。方法 选取120例于2021年03月～2022年03月治疗的复杂性肾结石患者,根据治疗方法分为研究组和对照组,各60例。对照组单独使用经皮肾镜引导钬激光碎石,研究组用经皮肾镜联合输尿管软镜引导钬激光碎石。比较两组患者的手术相关指标、结石清除率、并发症情况,并比较两组患者手术前后的肾功能指数及尿液代谢情况。结果 研究组手术时间比对照组长,术中出血量比对照组多,但住院时间比对照组短(P<0.05)。结石清除率比较,研究组高于对照组,研究组并发症发生率少于对照组(P<0.05);两组患者手术后肾功能指数、尿液代谢异常发生率都较手术前有明显改善,且研究组的改善效果比对照组更优异(P<0.05)。结论 经皮肾镜联用输尿管软镜引导钬激光进行碎石对复杂肾结石有确切疗效,能够有效提高结石清除率,明显改善患者的肾功能水平,降低患者尿液代谢异常率。     

The role of pararenal collaterals in assessing renal artery stenosis before and after percutaneous transluminal angioplasty

For the past several years, observation of flow direction in non-parenchymal renal artery branches, particularly during pharmacoangiography, has proved to be extremely reliable in the preoperative evaluation of the hemodynamic significance of renal artery stenoses. The advent of percutaneous transluminal angioplasty (PTA) has expanded the applications for these methods. Their value in PTA is demonstrated through five illustrative cases. In four stenoses shown to be significant before PTA, clinical responses were favorable. In one case undergoing PTA of an anatomically severe, but hemodynamically insignificant stenosis, blood pressure was unchanged after PTA. After PTA, observation of orthograde flow in the pararenal arteries confirms the adequacy of the procedure, and predicates a favorable clinical response.     

Experimental percutaneous renal embolization using BCG-saturated gelfoam

Adult mongrel dogs (20–25 kg) were used to evaluate the administration of Bacillus Calmette-Guerin (BCG) in conjunction with total renal embolization for possible application in the management of metastatic renal cell carcinoma (RCC). Kidneys were surgically removed at 1, 2, and 3 weeks postembolization, examined grossly and microscopically, and then compared with kidneys embolized in the same manner without BCG. The procedure stimulated the reticuloendothelial system more than did renal embolization alone, and although a high dose (6×10⁸ organisms) of BCG was administered, no complications were encountered. These results warrant a clinical trial of this technique in patients with advanced RCC. Research support was provided by the John S. Dunn Research Foundation and by the George Alfred Cook Memorial Fund.     

Percutaneous angioplasty for atherosclerotic renal artery disease: Effect on renal function in azotemic patients

Purpose We studied the effect of percutaneous transluminal renal angioplasty (PTRA) on renal function in azotemic patients with atherosclerotic renal artery stenosis.Methods The results of PTRA were analyzed retrospectively in 40 patients. There were 61 stenoses, 54 of which received balloon angioplasty; 7 had stent placement during the initial procedure, 6 for recurrent stenosis 6–18 months after PTRA.Results Technical success was achieved in 95% of cases. The complication rate was 15%, compared to 6% in nonazotemic patients. Mean creatinine rose from 1.9 ± 0.15 mg/dl (mean ± SEM) to 2.4 ± 0.17 mg/dl during the year before PTRA, stabilizing at 2.5 ± 0.57 mg/ dl for 1 year after PTRA. PTRA was clinically successful in 60% of patients; 40% showed further deterioration of renal function. Clinical failure was associated with residual renal artery stenosis and presence of intermittent claudication.Conclusion We conclude that PTRA helps salvage renal function in patients with azotemia and atherosclerotic renal artery stenosis.     

Tei指数评价水肿胎儿心室功能的定量研究

目的探讨Tei指数评价水肿胎儿心室功能的可行性。方法应用多普勒超声心动图测量17名孕龄在20～39周的水肿胎儿及55名孕龄在28～40周正常对照胎儿左、右心室多普勒时间间期,获得左、右心室Tei指数,比较水肿胎儿组与正常对照组Tei指数有无差异性。结果水肿胎儿组左、右心室Tei指数与正常对照组有差异性（P〈0．01）。结论Tei指数能简便、敏感地评估胎儿心脏整体收缩、舒张功能。     

经皮肾穿气压弹道碎石治疗肾结石69例

目的:探讨经皮肾穿气压弹道碎石治疗肾结石的临床疗效.方法:自2003年1月～2006年3月,采用经皮肾穿建立介入通道,以输尿管镜直视下经介入通道插入肾内寻找结石,置入气压弹道碎石机探针,用气压弹道碎石术治疗各型肾结石69例.结果:经皮肾穿介入通道建立成功率为100%,肾结石一次性治愈率98%(68/69),1例因内镜不能达到结石部位而改为手术治疗;2例形成小假道,不影响寻找结石或碎石.68例随访1～3年,经复查尿路平片(KUB)及静脉肾盂造影(IVP),无1例有残留结石,26例轻度肾积水消失,42例中重度肾积水有不同程度改善.结论:经皮肾穿气压弹道碎石治疗肾结石治愈率高、疗效显著,是一种痛苦小、安全性高的微创治疗方法.     

婴儿先天性梗阻性肾病术后99Tcm-EC利尿肾动态显像

目的　探讨利尿肾动态显像 (DR)评价婴儿先天性梗阻性肾病术后肾功能的价值。方法　 32例术前确诊为先天性梗阻性肾病合并积水的患儿 ,术后行 1～ 4次DR复查。术后患肾功能的定性评估结合双肾形态、肾图及各项功能指标综合分析。单肾积水术后患肾功能定量评估以患肾血流灌注率 (BPR)为指标。结果　定性评估单个肾术后共 6 7次DR检查中肾功能的转归 ,完全好转 6次 (9 0 % ) ,明显好转 35次 (5 2 2 % ) ,好转 7次 (10 4 % ) ,不变 9次 (13 4 % ) ,恶化 10次 (14 9% )。各组BPR变化值差异有极显著性 (F =7 77,P <0 0 0 1) ;术后肾功能变化的定性与定量评估结果差异无显著性 (χ2 =0 0 17,P =0 897)。肾重复畸形术后转归较好。在影响单肾积水术后BPR提高的因素中 ,BPR提高与术前患肾面积比呈正相关 (r=0 5 5 2 ,P <0 0 5 ) ,与术前BPR值呈负相关 (r =0 85 2 ,P <0 0 0 1) ,与手术时年龄和随访间隔无相关性 (r=0 0 11,0 16 6 ,P均 >0 0 5 )。结论　DR评价婴儿先天性梗阻性肾病术后肾功能有较好的应用价值。     

多带宽DTI-IVIM技术评估肾移植术后早期移植肾功能受损的价值

目的 探讨多带宽扩散张量成像-体素内不相干运动(multiband DTI-IVIM)技术评估肾移植术后早期不同程度受损移植肾功能的价值。方法 前瞻性收集异体肾移植术后2~4周病人92例行常规MRI、multiband DTIIVIM MRI检查。根据估算肾小球滤过率(eGFR)将病人分为3组:组1,eGFR≥60 mL/(min·1.73 m^2)(45例);组2,30 mL/(min·1.73 m^2)≤eGFR<60 mL/(min·1.73 m^2)(27例);组3,e GFR<30 mL/(min·1.73 m^2)(20例)。测量移植肾皮髓质的表观扩散系数(ADC)、单纯扩散系数(ADCslow)、微循环灌注系数(ADCfast)、灌注分数(f)、各向异性分数(FA)。采用配对t检验分析比较皮髓质间各参数值差异;采用单因素方差分析比较组间各参数值的差异;采用Pearson相关分析研究移植肾各参数值与eGFR间的相关性以及皮髓质FA值与其他各参数值的相关性。结果 组1肾皮质FA值低于髓质,余参数值高于髓质(P<0.05),组2、组3的ADCslow、ADCfast值及组2的f值皮髓质间差异无统计学意义(P>0.05)。组2肾皮髓质ADC、ADCslow、皮质f值及髓质FA值均低于组1(P<0.05)。组3肾皮髓质ADC、髓质ADCslow及髓质FA值均低于组2(P<0.05)。组3肾皮髓质ADC、ADCslow、f值、皮质ADCfast值及髓质FA值均低于组1(P<0.05)。各参数中,髓质FA值对组1和组2、组2和组3、组1和组3鉴别诊断效能最高(AUC分别为0.855、0.831、0.983);联合DTI-IVIM参数鉴别各组的能力最高(AUC分别为0.954、0.885、1.000)。除髓质ADCfast值、f值及皮质FA值外,移植肾各参数值与eGFR均呈中度正相关(r值为0.333~0.707,P<0.05)。髓质FA值与皮髓质ADC值、皮髓质ADCslow值及髓质f值均呈中度正相关(r值为0.335~0.526,P<0.05)。结论 multiband DTI-IVIM联合DTI和IVIM技术,可以评估并鉴别移植术后早期不同功能状态的移植肾功能。     

右美托咪定对经皮肾镜取石术患者术后肾功能和认知功能影响

目的 探讨右美托咪定对经皮肾镜取石术（percutaneous nephrolithotomy, PCNL）患者术后肾功能和认知功能的影响。方法 选择2020年1月-2021年12月经宜宾市第一人民医院确诊并进行经皮肾镜取石术的102患者为研究对象,按照随机数字法分为丙泊酚组（n=51）与右美托咪定组（n=51）。两组经相同方法诱导后,丙泊酚组给予0.1~0.3 ug/kg/min瑞芬太尼以及3~5 mg/kg/h丙泊酚。右美托咪定组给予0.1~0.3 ug/kg/min瑞芬太尼及0.2~0.4 μg/kg/h右美托咪定。观察记录两组患者术前1 d、术后1 h、1 d、3 d血肌酐（creatinine,Cr）、血尿素氮（blood urea nitrogen, BUN）水平以及手术前后的简易精神状态测量量表（mini-mental state examination, MMSE）和蒙特利尔认知功能评估量表（montreal cognitive assessment, MoCA）评分数据。结果 术后1 h、1 d、3 d,两组血清Cr水平均逐渐升高并在术后1 d达到高峰,术后3 d逐渐降低（P<0.05）。右美托咪定组术后1 h、1 d、3 d血清Cr水平均低于丙泊酚组（P<0.05）。术后1 h、1 d、3 d,两组血清BUN水平均逐渐升高,且在术后1 d达到高峰,术后3 d逐渐降低（P<0.05）,但右美托咪定组术后1 h、1 d、3 d血清BUN水平均低于丙泊酚组（P<0.05）。术后,两组MMSE、MoCA评分均明显降低（P<0.05）,但右美托咪定组MMSE、MoCA评分高于丙泊酚组（P<0.05）。结论 经皮肾镜取石术中应用右美托咪定全麻相比丙泊酚更能够减少对患者肾功能的损伤,同时降低患者术后认知功能的影响。     

Prognostic value of renal vascular impedance in patients with hepatic cirrhosis in risk for developing hepatorenal syndrome

Aim of the work

To evaluate the intrarenal arterial changes in patients with hepatic cirrhosis to anticipate development of hepatorenal syndrome.

Materials and methods

Study population included 155 subjects divided into five groups; group (1): control subjects; group (2): patients with compensated cirrhosis; group (3): patients with decompensated cirrhosis without ascites; group (4): patients with decompensated cirrhosis and ascites; and group (5): patients with hepatorenal syndrome.

Results

In group 5; the mean value of RI was significantly high as well as groups 4 and 3, as related to groups 2 and 1. The PI was significantly high in groups 5, 4, and 3, as related to groups 2 and 1. High RIs were received in 83% of group 5, 56% of group 4, 41% of group 3, 32% of group 2, and 8% of group 1. On the other hand, high PIs were received in 83% of group 5, 78% of group 4, 71% of group 3, 41% of group 2, and 3% of group 1. Renal vascular impedance measurement had sensitivity of 71%, specificity of 96%, PPV of 92%, and NPV of 86%.

Conclusion

Renovascular impedance values are good specific and positive predictive tools for hepatorenal syndrome development in patients with hepatic cirrhosis.     

Alterations in renal morphology and function after ESWL therapy: evaluation with dynamic contrast-enhanced MRI

Contrast-enhanced gradient-echo MRI was used to evaluate morphological and functional alternations in the kidneys after extracorporeal shock wave lithotripsy (ESWL). Dynamic MRI with a temporal resolution of 10 s per image was performed by repeated imaging in the coronal plane after administration of gadolinium-DTPA (0.1 mmol/kg) before and after ESWL for renal calculi in 25 patients. Before ESWL 22 patients had normally functioning kidneys, characterised by a marked decrease in signal intensity in the renal medulla 30–40 s after the onset of cortical perfusion. After ESWL 8 patients had functional abnormalities: in 2 cases the medullary signal decrease was disturbed throughout the whole organ, while 6 kidneys demonstrated regional loss of concentrating ability in the medulla. Morphological alterations (oedema with blurred contours and loss of corticomedullary differentiation; parenchymal haemorrhage and haemorrhage in a cortical cyst; subcapsular, perirenal and pararenal haematoma) were detected in 9 cases. Haemorrhage was encountered more often after administration of more than 2500 shock waves; however, no such correlation was seen in the kidneys with functional disturbances following ESWL therapy. MRI proved to be a sensitive method for the assessment of morphological and functional alterations after ESWL, but longer follow-up studies are required to identify the clinical impact of these early changes.