肾盂内压增高对肾损伤的实验研究

目的:建立肾盂内高压灌流的动物模型,观察肾盂内高压灌流对肾单位结构的影响,探讨输尿管镜及经皮肾镜时肾盂内灌流的安全压力。方法:构建肾盂灌注的动物模型,灌注压力为6.67kPa、13.33kPa、20.00kPa、26.66kPa(50mmHg、100mmHg、150mmHg、200mmHg)保持10min后用18G穿刺针取肾上、中、下三处15mm肾组织固定后送检,作为第一阶段肾组织标本。第二阶段在第一阶段基础上分四组即(6.67kPa组、13.33kPa组、20.00kPa组、26.66kPa组)在恢复常压10min后再分别增压到6.67kPa、13.33kPa、20.00kPa、26.66kPa保持10min后取标本,恢复常压10min后再重复一次。电镜下观察各压力梯度及时间累积下,肾小球、肾小囊、近曲肾小管及肾间质的改变。结果:肾盂内灌注压在6.67kPa时,在不同的时间累积里,肾小球、肾小囊、近曲肾小管及肾间质的改变不明显。肾盂内灌注压在13.33～26.66kPa时,在不同的时间累积里,肾小球、肾小囊的改变不明显;但近曲肾小管及肾间质的损伤改变明显,近曲肾小管上皮细胞微绒毛脱落、细胞膜及细胞器破裂等,肾间质肿胀、炎性细胞侵润等变化,并随时间积累而加剧。结论:肾盂内灌注压持续达到13.33kPa以上时,随着时间的累积,对近曲小管和肾间质有不同程度的损伤;在输尿管镜手术及经皮肾镜手术时,应保持低压及流出道通畅,避免肾盂内灌注压长时间持续达到13.33kPa以上,以免对肾组织造成损伤。

Experimental study of nephron injury caused by high renal pelvic pressure

Objective:To observe the effects of high-pressure perfusion on the renal unit structure,and to explore the safe perfusion pressure during ureteroscopy and percutaneous nephrolithotomy through establishing the animal model of high pressure intrapelvic perfusion.Method:The animal models of renal pelvis perfusion with perfusion pressure 6.67kPa,13.33kPa,20.00kPa,26.66kPa(50mmHg,100mmHg,150mmHg,200mmHg)for 10minutes,the kidney tissures were obtained by puncture at each perfusion pressure.Then repeated this precedure twice.The morphologic changes of the glomeruli,the renal capsule,renal proximal tubular interstitial were observed by electron microscope at each grade pressure.Result:When renal pelvic perfusion pressure in 6.67kPa,the glomeruli,the renal capsule,renal proximal tubular interstitial changes were not obvious with accumulated time.Renal pelvic perfusion pressure in the 13.33-26.66kPa with accumulated time,no significant changes in the renal capsule and the glomeruli;but significant changes in proximal tubular and renal interstitial.Proximal tubular epithelial cells loss of microvilli,rupture of membranes and organelles,interstitial swelling,inflammatory cell infiltration and other changes were observed with perfusion pressure 13.33kPa to 26.66kPa and with accumulated time.Conclusion:Renal unit structure damage would occur when perfusion pressure exceeds 13.33kPa,the proximal tubule and interstitial damage were observed with accumulated time.It should be careful to maintain the perfusion pressure lower than 13.33kPa during during ureteroscopy and percutaneous nephrolithotomy,and the outflow tract should be kept smoothly for protecting the nephron from injury by high perfusion pressure.