【摘要】 目的评估和比较标准通道经皮肾镜术(PCN)和微通道经皮肾镜术(MPCN)对猪孤立肾皮质的损伤。方法对12只雌性猪行左肾切除术,建立孤立肾模型,然后随机分为PCN组和MPCN组,2周后在B超引导下行经皮肾穿刺造瘘术。PCN组用Amplatz筋膜扩张器扩张到24F,MPCN组扩张到16F。两组分别于术前、术后测定尿素氮、肌酐、尿钾、尿钠、尿氯、血清中总二氧化碳(ECO2)含量,并进行比较。4周后处死动物,将肾摘除,肉眼和显微镜下观察其组织学差异。切除造瘘道周围瘢痕组织,行Massion染色,用数字图像分析技术测量瘢痕面积,并计算造瘘道瘢痕体积和肾皮质的体积,比较两组瘢痕体积及该瘢痕体积占肾皮质体积的百分率。结果猪孤立肾肾穿刺造瘘模型建立成功。两组组内术前和术后尿素氮、肌酐、尿钾、尿钠、尿氯、血清ECO2含量比较,差异均无显著性(t=0.277～1.718,P>0.05)。两组间肾肉眼和组织学观察无明显差异。PCN组和MPCN组的造瘘道的瘢痕体积及其占整个肾皮质体积的百分比比较,差异无显著性(t=1.391、1.798,P>0.05)。结论PCN和MPCN对肾脏功能的影响和肾皮质的损伤都很小。MPCN在减少孤立肾肾皮质的损伤方面较PCN并无明显优势。更多还原

【Abstract】 Objective To assess and compare the effects of standard percutaneous nephrostomy (S-PCN) and minimally invasive percutaneous nephrostomy (MI-PCN) on renocortical damage of solitary kidney in pig. MethodsA solitary-kidney animal model was established by removing the left kidney in 12 female pigs, which were randomized to S-PCN and MI-PCN groups, an ultrasound guided PCN was done two weeks later. The tracts in S-PCN group were dilated to 24F with Amplatz fascial dilator, and that in MI-PCN to 16F. Urea nitrogen, serum creatinine, urine kalium, natrium, chlorine, and total amount of carbon dioxide in serum (ECO2) were detected, before and after surgery. Four weeks later, the pigs were sacrificed and the kidneys removed for macroscopic and histologic examination. The scar tissues surrounding the tracts were dissected and Massion staining done, the area of scar was measured with digital image analysis, the volumes of scar and renal cortex were calculated. The volumes of scar and that accounting for the volume of renal cortex in percentage between the two groups were compared.ResultsA PCN model in pigs with solitary kidney was successfully set up. The above items detected, before and after surgery, showed no statistical differences between the two groups (P>0.05), and no significant difference was found in terms of gross and microscopic observation of the kidney. There was no statistical difference of scar volume (P>0.05) and that ratio to total renal cortex volume (P>0.05) between the two groups. ConclusionBoth S-PCN and MI-PCN have a very little impact on renal function and renal cortex. MI-PCN has no obvious superiority over S-PCN in reducing parenchymal damage of solitary kidney.更多还原