摘要
目的:评价核素肾动态显像对单侧上尿路梗阻肾功能及其术后疗效的评估能力,探讨该显像方法对临床外科治疗的指导意义。方法:回顾性分析2014年1月~2017年7月我院收治的确诊为单侧上尿路梗阻患者105例。通过放射性核素锝标记二乙三胺五醋酸(^(99m)Tc-DTPA)行肾动态显像,应用Gates法测定肾小球滤过率(glomerular filtration rate,GFR),按术前患肾GFR下降程度分为轻、中、重及极重度组,并对肾图类型进行分析。患者均行手术解除梗阻,术后1~16个月复查肾动态显像,分析手术前后GFR及恢复差值、术后GFR增长值与复查时间的关系。结果:轻、中、重度组GFR均值较术前比较有明显增加,差异均有统计学意义(P<0.01);极重度组结果与术前比较,差异有统计学意义(P=0.032);轻度组与中度组间、重度组与极重度组间GFR恢复差值的差异无统计学意义(P>0.05);但轻、中度组术后GFR恢复差值大于重度、极重度组,差异有统计学意义(P<0.05)。极重度组3例经过临床评估行肾切除术;5例解除梗阻3个月后GFR恢复到10ml/(min·1.73m^2)以上,平均恢复(5.43±1.37)ml/(min·1.73m^2);所有患者中有16例术后GFR不同程度的降低。梗阻肾的4种肾图类型中,低水平延长型的患肾术后肾小球滤过功能恢复明显低于其余3组。不同复查时间的组别间术后GFR增长值的差异无统计学意义(F=1.056,P=0.352)。结论:上尿路梗阻解除后患肾的平均恢复能力与术前损害程度相关;部分术前评估在以往认为可切除的患肾,解除梗阻后GFR能恢复至可保留的水平。核素肾动态显像获得的GFR值及肾图不仅能反映单侧上尿路梗阻肾功能的受损程度,还可以评估其解除梗阻后功能恢复的能力,方法简便,可重复性好,对临床外科的治疗有重要的指导意义。
Objective：To evaluate the value of radionuclide renal dynamic imaging in the postoperative efficacy of unilateral upper urinary tract obstruction,and to explore its instructive usefulness for clinical surgical treatment.Method：A retrospective analysis of 105patients diagnosed with unilateral upper urinary tract obstruction were enrolled from January 2014to July 2017.All patients were performed renal dynamic imaging with ^99mTc-DT-PA and glomerular filtration rate（GFR）,and renograms were acquired at the same time.According to the GFR of affected kidney,the patients were divided into four groups including mild group,moderate group,severe group and extremely severe group.GFR and recovery difference were analyzed before and after operation.The relationship between postoperative GFR growth and follow-up period was also analyzed.Result：In mild,moderate and severe group,the GFR value increased and the difference was statistically significant（P〈0.01）.The difference of GFR recovery between the mild and moderate group was greater than that in the severe group,the difference was statistically significant（P〈0.05）.The GFR mean value recovered to 10ml/（min·1.73m^2）in five cases,and regained averagely（5.43±1.37）ml/（min·1.73m^2）.There were four kinds of renogram types in the affected kidney,and the kidney function recovered less in the type of low level elongation.In following up,there was no difference of GFR growth among three groups（F=1.056,P=0.352）.Conclusion：The average recovery ability of the kidney is related to the degree of preoperative kidney damage.The clinical management may be changed especially to the kidneys which supposed to be resected.The function of these kidneys could recover to the level of kidney reserve after the surgery.Radionuclide renal dynamic imaging provided GFR value and renogram,which showed the damage degree of effected kidney and predicted the ability of recovery after the operation.Its feasibility and repeatability made it an important guidance for the surgical therapy of unilateral upper urinary tract obstruction.
出处
《临床泌尿外科杂志》
2017年第11期830-835,845,共7页
Journal of Clinical Urology
