急性压力灌注对不同程度肾积水模型兔肾脏的损伤

目的:探讨输尿管套扎法建立兔肾积水模型的可行性及急性压力灌注对不同程度积水肾肾脏损伤的影响,为临床经皮肾镜和输尿管镜过程中灌注压力的选择提供依据。方法:健康新西兰大白兔45只,随机分为正常组(N组,n=5)、轻度积水组(M组,n=20)和重度积水组(S组,n=20)3组。轻度积水及重度积水组模型采用套管法构建。轻度积水组与重度积水组分别于结扎后3,7d行彩色多普勒超声检查以判别积水程度。M组和S组随机分为M0-M3和S0-S3 4个压力灌注亚组,M0-M3和S0-S3分别行0,20,60,100mmHg压力灌注,N组行100mmHg压力灌注。术后48h取肾脏标本,免疫组化检测标本中TNF-α及IL-8的表达。结果:输尿管套扎法模型构建成功率达90%,与正常肾脏相比,结扎后3d行彩色多普勒超声检查,M组可见集合系统分离,有少量液性暗区;结扎后7d检查,S组可见集合系统分离明显,肾皮质变薄,液性暗区占据肾脏大部分区域。M组行0,20,60mmHg灌注时IL-8、TNF-α表达量均无明显变化(P>0.05),行100mmHg灌注时IL-8及TNF-α表达量明显增加(P<0.05);S组行0,20mmHg灌注时IL-8、TNF-α表达量均无明显变化(P>0.05),行60,100mmHg灌注时IL-8、TNF-α表达量明显增加(P<0.05);N组行100mmHg灌注时IL-8、TNF-α表达量与M0、S0相比无明显差别(P>0.05)。结论:输尿管套扎法建立兔肾积水模型具有可行性,不同程度积水肾对急性压力灌注的耐受能力不同,高灌注压力更容易对积水程度重的肾脏造成损伤,在经皮肾镜和输尿管镜治疗结石过程中应尽量减少过高压力灌注以保护积水肾脏。

Renal Damages Induced by Various of Irrigation Pressures in Rabbits with Mild or Severe Hydronephrosis

Objective:To study the possibility of establishment of an animal model of hydronephrosis with the method of ligation and the degrees of damages induced by various of irrigation pressures in mild or severe hydronephrosis and to provide reference values for clinical work during endo-urological procedures.Methods:A total 45 rabbits were randomly divided into three groups:normal group(group N,n=5),mild hydronephrosis group(group M,n=20),and severe hydronephrosis group(group S,n=20).Both mild and severe hydronephrosis models were induced by ligating ureters with plastic cannulas.In each group,rabbits were randomly divided into four subgroups(M0to M3 and S0to S3)with 5rabbits respectively.Each subgroup was respectively perfused with 20,60,and 100 mmHg pressure fluid.In normal group,no surgical procedure wasdone and rabbits were only perfused with 100 mmHg pressure fluid.The prefusion time was lasted for one hour.After that,the kidneys were harvested for measurement of the expression of TNF-αand IL-8by immunohistochemical SP method and computer quantitative image analysis.Results:The success rate of model establishment was 90%.In group M3,TNF-α,IL-8was significantly increased(P<0.05);in groups M1,M2,and M3,no abnormalities were observed(P>0.05).For S group,abnormalities were observed in S2(P<0.05).In group N,under the irrigation of 100 mmHg,TNF-αand IL-8has no significantly difference from that in groups M0 or S0.Conclusion:It is feasible to establish a rabbit model of hydronephrosis with the method of plastic cannula.The toleration to high irrigtion pressure was different between mild and severe hydroneprosis.Severe hydronephrosis kidneys were easier to suffer damage when expose to high perfusion pressure.The high perfusion pressure should be controlled during endourgical procedures in the context of hydronephrosis.