利尿肾动态显像评价离断式肾盂成形术治疗单侧肾盂输尿管连接部狭窄

目的 应用利尿肾动态显像评价离断式肾盂成形术治疗单侧肾盂输尿管连接部狭窄（UPJO）的疗效，分析与术后患肾功能改善可能相关的因素。方法 回顾性分析因单侧UPJO接受离断式肾盂成形术的患者42例。全部患者均于手术前后行利尿肾动态检查，且对侧肾功能正常。以注射显像剂后2~3 min时的患肾摄取率作为其相对肾功能（RRF）。根据肾图曲线对速尿的反应（RFS）情况，将引流梗阻性质分为机械性梗阻和非机械性梗阻。观察术后患肾功能改善与引流改善状况；分析术后患肾功能改善与术后引流改善、术前患肾功能以及术前梗阻类型之间的相关性。结果 术前患肾RRF为（40.40±13.45）%，术后为（44.26±13.35）%，较术前有明显提高（P=0.01）。术后患肾功能改善组、无变化组与恶化组的引流改善率分别为53.33%（8/15）、56.00%（14/25）和50.00%（1/2），术后患肾功能改善与引流改善无明显相关性（P=0.21）。术后患肾功能改善与术前患肾功能及梗阻类型均无明显相关性（P=0.40、0.60）。结论 离断式肾盂成形术可提高UPJO患肾功能，并改善部分患肾引流状况，且术后患肾功能改善不依赖于引流改善；但术前患肾功能及梗阻类型尚无法用于术后患肾功能改善的预测。

Diuretic renography in evaluation on efficacy of Anderson-Hynes pyeloplasty in patients with unilateral ureteropelvic junction obstruction

Objective To evaluate the efficacy of Anderson-Hynes pyeloplasty in unilateral ureteropelvic junction obstruction (UPJO) patients using diuretic renography, and to analyze the possible relative factors to postoperative renal function improvement. Methods Forty-two patients who underwent Anderson-Hynes pyeloplasty for unilateral UPJO were retrospectively collected. All patients underwent diuretic renography before and after operation. The contralateral kidney had neither morphological nor functional abnormalities. The relative renal function (RRF) of affected kidney was expressed as its uptake rate in second to third minute post administration of imaging agent. Obstructive or non-obstructive hydronephrosis were classified according to the response to furosemide stimulation (RFS). Improvement of postoperative renal function and drainage were recorded. The correlation between postoperative renal function improvement with drainage improvement, preoperative renal function, and preoperative obstructive types, were analyzed respectively. Results RRF of affected kidney before operation was (40.40±13.45)%, post operation was (44.26±13.35)%, indicating a statistically significant renal function improvement after surgery (P=0.01). Patients with postoperative drainage improvement were 53.33% (8/15), 56.00% (14/25) and 50.00% (1/2) in the group of renal function improved, unchanged and deteriorated, respectively (P=0.21). There was no significant correlation between postoperative renal function improvement with preoperative renal function (P=0.40), neither with preoperative obstructive types (P=0.60). Conclusion Anderson-Hynes pyeloplasty could improve the involved renal function for UPJO patients, and improve some patients' drainage conditions. However, there is no significant correlation between postoperative renal function improvement with drainage improvement. Preoperative renal function and obstructive types could not be used to predict the improvement of renal function post operation.