Ortapamuk Hülya, Naldoken Seniha, Tekdogan Umit Yener, Aslan Yilmaz, Atan Ali
Department of Nuclear Medicine, Ankara Numune Research and Training Hospital, Ankara, Turkey.
Ann Nucl Med. 2003 Dec;17(8):663-8. doi: 10.1007/BF02984972.
Pyeloplasty is a widely accepted method for the treatment of ureteropelvic junction obstruction (UPJO). Surgery has long been thought to affect postoperative renal function. However, controversies still exist on the functional studies that can be used to indicate which renal units will benefit from surgery. In this study, the correlation between differential renal function (DRF) and other preoperative parameters was examined to determine which parameter more accurately predicts recovery of renal function in adult obstructed kidneys.
MATERIALS & METHODS: In this study, the authors evaluated 32 patients with UPJO. In all patients, standart diuretic Tc-99m DTPA renal scans were performed preoperatively and 6 months after surgery. Patients were divided into two groups according to the preoperative DRF (> or = 30%, n = 22, group I and < 30%, n = 10, group II). Second type classification was made according to the postoperative DRF improvement as improved (group A, n = 13) and not improved (group B, n = 19). These groups were then compared regard to variables which were defined as symptoms, age at operation and ultrasonographic findings. We also evalulated whether preoperative parenchymal function is important to predict improvement in drainage half-time (T1/2).
While preoperative drainage half-time was 39.6 +/- 15.9 minutes, postoperative half-time decreased to 16.9 +/- 6.8 minutes (p < 0.001). The mean DRF did not improved significantly after surgery compared with preoperative values (32.03 +/- 9.42% versus 36.16 +/- 9.60%). When comparing the patients with preoperative DRF > or = 30% (group I, DRF 38 +/- 0.8%) to those who had an initial DRF below 30% (group II, DRF 22.8 +/- 5.2%), postoperative DRF was 41.22 +/- 5.72 in group I and 25.00 +/- 6.22 in group II. The difference was significant (p < 0.01). The patients in group I and II showed improvement in 50% and 20%, respectively. Age, clinical presentation and ultrasonographic findings did not affect functional outcome after pyeloplasty. We could not find any correlation between preoperative DRF and the degree of improvement in T1/2.
Renal function improves after pyeloplasty with regard to the initial level of split renal function in adult obstructed kidneys. Improvement may not be observed especially in patients with DRF less than 30%.
肾盂成形术是治疗输尿管肾盂连接部梗阻（UPJO）广泛认可的方法。长期以来，手术一直被认为会影响术后肾功能。然而，在可用于表明哪些肾单位将从手术中获益的功能研究方面仍存在争议。在本研究中，检查了分肾功能（DRF）与其他术前参数之间的相关性，以确定哪个参数能更准确地预测成人梗阻性肾脏的肾功能恢复情况。
在本研究中，作者评估了32例UPJO患者。所有患者术前及术后6个月均进行了标准利尿Tc-99m DTPA肾扫描。根据术前DRF将患者分为两组（≥30%，n = 22，I组；<30%，n = 10，II组）。根据术后DRF改善情况进行二次分类，分为改善组（A组，n = 13）和未改善组（B组，n = 19）。然后比较这些组在症状、手术年龄和超声检查结果等变量方面的情况。我们还评估了术前实质功能对预测引流半衰期（T1/2）改善是否重要。
术前引流半衰期为39.6±15.9分钟，术后半衰期降至16.9±6.8分钟（p<0.001）。与术前值相比，术后平均DRF无显著改善（32.03±9.42%对36.16±9.60%）。将术前DRF≥30%的患者（I组，DRF 38±0.8%）与初始DRF低于30%的患者（II组，DRF 22.8±5.2%）进行比较，I组术后DRF为41.22±5.72，II组为25.00±6.22。差异有统计学意义（p<0.01）。I组和II组患者的改善率分别为50%和20%。年龄、临床表现和超声检查结果不影响肾盂成形术后的功能结局。我们未发现术前DRF与T1/2改善程度之间存在任何相关性。
对于成人梗阻性肾脏，肾盂成形术后肾功能相对于初始分肾功能水平有所改善。尤其是DRF小于30%的患者可能未观察到改善。
