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目的探讨标准经皮肾镜取石术对上尿路结石合并肾积水患者肾血管阻力指数的影响。方法 60例单侧上尿路结石并对侧肾功能正常患者按患肾积水程度分为轻度(15例)、中度(32例)、重度(13例)。采用标准通道超声联合气压弹道经皮肾镜碎石,其中单通道52例、双通道8例。应用彩色多普勒血流显像测定术前24h和术后0、48、120h双肾肾血管阻力指数。比较手术前后各组肾血管阻力指数的差异。结果经皮肾镜取石术术后各组患侧肾脏肾血管阻力指数即刻升高,并维持至术后48h,与术前比较有显著性统计学差异(P<0.01),术后5d恢复至术前水平(P>0.05);各组健侧肾脏术后肾血管阻力指数变化特点与患肾相同。结论标准经皮肾镜取石术可造成早期双肾血流降低,而双肾血流改变与术前肾积水程度无关。
Objective To investigate the effect of standard percutaneous nephrolithotomy on renal vascular resistance index in patients with upper urinary tract calculi and hydronephrosis. Methods Sixty patients with unilateral upper urinary tract stones were divided into mild (15 cases), moderate (32 cases) and severe (13 cases) patients with normal renal function. The standard channel ultrasound combined with pneumatic ballistic percutaneous nephrolithotomy, of which 52 cases of single-channel, dual-channel in 8 cases. Color Doppler flow imaging was used to measure the renal renal vascular resistance index at 24 hours and 0,48,120 hours after operation. The difference of renal vascular resistance index before and after operation was compared. Results The renal vascular resistance index of the ipsilateral renal tubules in each group immediately after percutaneous nephrolithotomy was maintained at 48 h postoperatively, which was significantly different from that before operation (P <0.01) Preoperative level (P> 0.05). The changes of renal vascular resistance index of contralateral kidney in each group were the same as those of the affected kidney. Conclusion Standard percutaneous nephrolithotomy can reduce the early renal blood flow, while the renal blood flow changes have nothing to do with the degree of preoperative hydronephrosis.