肾盂恒压灌注对肾损伤的实验研究

目的:研究兔单侧输尿管逆行恒压灌注后对肾脏的影响,为临床评价内腔镜操作所致肾脏的改变提供理论依据。方法:分别建立左侧输尿管皮肤造口的动物模型:健康家兔50只,随机分为5组(每组10只),假手术组只造瘘不灌注,灌注组输尿管造瘘后立即行逆行灌注,灌注压力分别为60、80、100、120cmH2O(1cmH2O=0.098kPa),术后每天留取尿标本定量测定尿白蛋白(AlB),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白蛋白增高,术后第1天与术前相比差异均有统计学意义(P<0.01),且术后第一天在各组间比较差异有统计学意义(P<0.05),从60cmH2O到120cmH2O各组尿蛋白恢复的时间分别为3、4、5、6天;形态学上表现:肉眼观灌注后肾脏颜色逐渐变深,包膜紧张,肾脏较前增大,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。显微镜下观察见肾集合系统扩张,随着压力增高高倍镜下每个视野扩张的肾小球、肾小管所占的比例越来越多,扩张的程度越来越重。结论:压力为60～120cmH2O对兔肾盂进行灌注时,在短期内会出现尿白蛋白增高及形态学改变,提示肾功能损害,且压力越高,肾功能损害越严重,恢复时间越长。

Experimental study on the kidney damage by constant pressure irrigation into renal pelvis

Objective:To explore the renal damage effect of flushing Sodium Chloride into pelvis unilaterally at constant intrapelvic pressure, and provide a theory basis for clinical practice for the treat of upper urinary tract diseases by endoscope.Methods:Fifty rabbits underwent left tube ureterocutaneostomy as a method of urinary diversion, all rabbits were divided randomly into five groups:the flushing group perfused immediately after ureterocutaneostomy ,and the intrapelvic pressure is 60,80,100,120 cmH_2O,but the sham-operated group didn't flush.Urinary albumin were examined every day after operation,we also got pathological examination of nephridial tissue continually.Results:All the flushed rabbits had the change of urinary albumin,the difference of urinary albumin was of statistical significance between the before and the first day after treatment(P< 0.01), statistic the differences of urinary albumin in the first day after treatment among groups have prominent significance(P< 0.05). They have gotten back in the 3th,4th,5th,6th day compared with the aggravated intrapelvic pressure. The histomorphometry showed that the kidney had become larger than before after flushed,parts of the kidney have effusion,they are sixteen in nineteen have majority of effusion.Renal pelvis and calyoes dilatationthe,the inflammatory cells corrosion and cast by microscope. The higher of pressure,the more obviously of the dilation of pelvis and calyoes,and the longer time of functional recovery.Conclusions:When we flushed the pelvis at 60-120 cmH_2O,we could see the momently change of the urinary albumin and histomorphy ,the higher of pressure,the more of renal function were damaged,and the longer time of functional recovery.