多通道经皮穿刺对肾功能的影响。

Renal functional effects of multiple-tract percutaneous access.

机构信息

Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana 46202-5120, USA.

出版信息

J Endourol. 2009 Dec;23(12):1951-6. doi: 10.1089/end.2009.0159.

DOI:10.1089/end.2009.0159

PMID:19909077

Abstract

INTRODUCTION

Percutaneous nephrolithotomy (PCNL) can involve establishing more than one access into the urinary collecting system. The present study examined whether multiple percutaneous accesses results in a more severe reduction in renal function than that after single-percutaneous access.

METHODS

Adult female pigs were anesthetized, and percutaneous access to the left urinary collecting system was achieved by puncturing the lower pole calyx (single-tract access, n = 16) or serially puncturing the lower pole, interpolar region, and upper pole calyces [multiple (three)-tract access, n = 11]. Renal function measurements included glomerular filtration rate and effective renal plasma flow, and were taken immediately before and 1.5 and 4.5 hours after percutaneous access. We also examined glomerular function in a group of adult patients with normal preoperative serum creatinine (Cr) levels (<or=1.4 mg/dL) who underwent either unilateral single-tract PCNL (23 patients) or unilateral multiple (two)-tract PCNL (10 patients). Access tracts were dilated to 30F with a NephroMax balloon dilator system in animal and human patients.

RESULTS

Single- and multiple-tract percutaneous access procedures in pigs resulted in a similar renal functional response; both glomerular filtration rate and effective renal plasma flow significantly declined by approximately 60% immediately after access and remained depressed throughout the experimental observation period. A retrospective analysis of patients with normal serum Crs (<or=1.4 mg/dL) who underwent single- or multiple-tract PCNL demonstrated that the procedures produced similar and significant increases in serum Cr on postoperative day 1 (0.33 +/- 0.09 [standard error of mean] mg/dL and 0.39 +/- 0.11 mg/dL, respectively) and day 2 (0.33 +/- 0.09 mg/dL and 0.25 +/- 0.09 mg/dL, respectively).

CONCLUSIONS

Multiple-tract access does not lead to a more severe reduction in renal function than single-tract access; that is, the acute renal hemodynamic response to PCNL appears independent of the number of access tracts.

摘要

介绍

经皮肾镜碎石术（PCNL）可能需要建立多个进入尿路收集系统的通道。本研究检查了多次经皮穿刺是否比单次经皮穿刺导致更严重的肾功能下降。

方法

成年雌性猪被麻醉，通过刺穿下极盏（单通道通道，n = 16）或连续穿刺下极、中极区和上极盏[多（三）通道通道，n = 11]来实现左侧尿路收集系统的经皮通道。肾功能测量包括肾小球滤过率和有效肾血浆流量，并在经皮通道前、1.5 小时和 4.5 小时立即进行。我们还检查了一组术前血清肌酐（Cr）水平正常（<or=1.4 mg/dL）的成年患者的肾小球功能，这些患者接受了单侧单通道 PCNL（23 例）或单侧多（两）通道 PCNL（10 例）。在动物和人类患者中，使用 NephroMax 球囊扩张系统将通道扩张至 30F。

结果

猪的单通道和多通道经皮穿刺程序导致相似的肾功能反应；肾小球滤过率和有效肾血浆流量在通道后立即显著下降约 60%，并在整个实验观察期间保持下降。对接受单通道或多通道 PCNL 的血清 Cr 正常（<or=1.4 mg/dL）的患者进行回顾性分析显示，两种手术在术后第 1 天（0.33 +/- 0.09 [均数的标准误差] mg/dL 和 0.39 +/- 0.11 mg/dL）和第 2 天（0.33 +/- 0.09 mg/dL 和 0.25 +/- 0.09 mg/dL）的血清 Cr 均有相似且显著增加。