彩色多普勒超聲在孤立腎腎結石微創經皮腎鏡取石術治療后血流動力學觀察中的價值

吳曉翔　鄭少培　周淑楨

【摘要】 目的：探究彩色多普勒超聲在微創經皮腎鏡取石術（MPCNL）治療孤立腎腎結石的腎臟血流動力學改變評價中的應用價值。方法：選取2014年6月-2017年3月孤立腎腎結石患者30例，均接受微創經皮腎鏡取石術治療，采用彩色多普勒超聲對孤立腎腎結石患者經治療后的腎臟血流動力學改變情況進行觀察分析。結果：孤立腎腎結石患者經MPCNL治療后，其腎主動脈PSV、EDV水平與術前相比，差異無統計學意義（P>0.05），RI水平明顯低于術前（P<0.05）；腎段動脈PSV、EDV水平與術前相比，明顯上升（P<0.05），RI水平與術前RI水平相比，差異無統計學意義（P>0.05）；腎葉間動脈PSV、EDV、RI水平與術前相比，均明顯上升（P<0.05）。結論：孤立腎腎結石患者接受微創經皮腎鏡取石術治療，對患者的腎臟損傷較少，且可以對患者的腎臟血流灌注情況進行改善，采用彩色多普勒超聲則可以較好對孤立腎腎結石患者治療前后的腎臟血流動力學改變情況進行評價。

【關鍵詞】 彩色多普勒超聲； 微創經皮腎鏡取石術； 孤立性腎結石； 血流動力學

【Abstract】 Objective：To investigate the value of color Doppler ultrasound in the evaluation of renal hemodynamic changes in minimally invasive percutaneous nephrolithotomy.Method：30 cases of solitary kidney calculi patients underwent minimally invasive percutaneous nephrolithotomy treatment were selected from March 2014 to March 2015，they were given color Doppler ultrasound in solitary kidney calculi，patients with renal hemodynamic changes after treatment were observed and analyzed.Result：Solitary kidney calculi were treated by MPCNL after treatment，compared the renal aortic PSV and EDV levels before and after treatment，the differences were not significant（P>0.05），RI levels were significantly lower than the preoperative（P<0.05）；compared with the levels of renal segmental artery EDV and PSV， increased significantly than before operation（P<0.05），the level of preoperative RI had little difference（P>0.05）；renal interlobar artery PSV， EDV and RI levels compared with the preoperative were significantly increased（P<0.05）.Conclusion：Solitary kidney calculi underwent minimally invasive percutaneous nephrolithotomy in treatment of renal injury，fewer patients，and can be used to improve the renal perfusion of patients，using color Doppler ultrasound can better renal hemodynamics before and after the treatment of solitary kidney calculi in patients with the change of the evaluation.

【Key words】 Color Doppler ultrasound； Minimally invasive percutaneous nephrolithotomy； Solitary kidney stones； Hemodynamics

First-authors address：The Fifth Affiliated Hospital of Guangzhou Medical University，Guangzhou 510700，China

doi：10.3969/j.issn.1674-4985.2017.25.028

孤立腎腎結石是上尿路結石的一種，其治療已經是泌尿外科治療的一個難題，因為孤立腎腎結石缺少對側腎代償，且較易出現并發癥的情況，為患者實施手術治療具有較大的風險。微創經皮腎鏡取石術（MPCNL）為患者實施治療具有微創的特點，其對患者的腎損害小，可以實施多次取石操作，患者在治療后恢復較快，已經是對孤立腎腎結石患者治療的主要方法[1-3]。腎血流動力學改變與患者的腎功能有著十分密切的關系，其血流動力學參數可以對其具體的腎臟病變情況進行反映。采用彩色多普勒（CDFI）對患者接受術前以及術后的血流動力學變化情況進行評價，從而對腎動脈血流灌注的具體狀態進行監視，已經是對腎小血管循環以及患者的腎實質損害進行評估的有效方法[4-6]。臨床上，主要通過腎臟的血流動力學參數來對孤立腎腎結石患者接受MPCNL治療后的病情隨訪、療效判定和預后評估提供依據[7]。CD……