经皮肾镜碎石术不同通道对肾结构及功能影响的实验研究

目的：探讨经皮肾镜碎石术标准通道（PCNL）及微通道（MPCNL）在不同的肾盂灌注压及不同时间对猪肾单位结构及功能的影响。方法：8只小猪随机分组为PCN组和MPCNL组，建立活体猪肾盂灌注冲洗模型。两组分别在灌注压100mmHg（1mmHg=0．133kPa）、200mmHg、300mmHg下分别持续肾盂灌注冲洗15min，45min，75min，然后分别在灌注前和灌注后不同时间穿刺肾实质，染色固定后，在光学及电子显微镜下观察肾单位结构变化，监测灌注前后不同时间的血常规、肾功能、电解质及血气的变化，并进行比较。结果：当灌注压力在200mmHg以下，时间45min以下时，两组术前、术后血常规、肾功能、电解质、血气差异均无统计学惠义（P〉0．05），两组间组织学改变无明显差异；当肾盂冲洗压力超过200mmHg，时间45min以上时，两组血钠、血HCOs。均降低（P〈O．05），肾组织学发生显著性变化。MPCN和LPCNL两组间的变化均无显著性差异。结论：随着灌注压力、时间的增加，MPCN和LPcNL对肾脏组织学的改变及血流动力学的影响逐渐增加，与MPcNL及PCNL通道大小无关。

Research on the Impact of Renal Structure and Function Under the Different Passage

Objective：To explore and compare the impact of minimally invasive percutaneous nephrostolithotomy （MPCNL） and standard percutaneous nephrostolithotomy （PCNL） on renal functions and renal structure under different perfusion pressure and time in pig model. Methods.. Eight pigs were randomized to PCNL and MPCN groups and high irrigation intrapelvic perfusion animal model was established under different pressure. Renal biopsy specimens were taken before irrigation,during irrigating for 15 minutes, 45 minutes, 75 minutes and after irrigation under 100 mmHg,200 mmHg,300 mmHg perfusion pressure. All specimens were observed under light and e- lectron microscope after staining and fixing. Blood routine, renal function, electrolyte,blood gas were detected and compared before and after irrigation as well. Results：The above data detected and the gross and microscopic observation of the kidney before and after irrigation, showed no significant difference when the perfusion pressure was 200 mmHg below and the time 45 minutes below; When perfusion pressure exceeded to 250 mmHg and the time exceeded to 45 minutes,the blood natrium and blood oxygen saturation were decreased and the nephron structure was damaged irreversiblely. No statistical differences between the two groups （P〉 0.05）. Conclusions： The higher the intrapelvic perfusion pressure, the more the change of hemodynamic and nephron structure,have nothing to do with the size of passage of mPCNL and PCNL.