Moskovitz B, Segev Y, Sopov V, Horev N, Groshar D, Nativ O
Department of Urology, Bnai Zion Medical Center, Israel.
Harefuah. 2005 Sep;144(9):626-9, 677, 676.
The study aimed to quantitatively investigate the effect of PCNL on global and regional function using quantitative single photon emission computerized tomography (SPECT) measurement of Tc-dimercaptosuccinic acid (DMSA) uptake by the kidneys (QDMSA).
Seventy nine patients with nephrolithiasis undergoing PCNL were studied by sequential QDMSA examination. There were 42 (53%) males and 37 (47%) females with mean age of 47 +/- 16 years. The initial study was conducted before PCNL procedure and the follow-up studies were performed 1.5-24 months after PCNL. Among 60 of the 79 (76%) patients, in whom PCNL was performed using upper or lower pole access, regional renal function of affected and non-affected pole of operated kidney was calculated separately.
There was no statistically significant difference between the uptake of treated kidney before and after PCNL procedure (11.9% +/- 5% vs 11.6% +/- 5%; t = 0.9, p = 0.368). The total renal functional volume of treated kidney was to be slightly decreased from 235cc +/- 62cc to 224cc +/- 59cc (t = 2.7; p = 0.011). The percent of injected dose per ml.. of renal tissue of treated kidney was not affected statistically (0.051 +/- 0.02 vs 0.053 +/- 0.02; t = 0.86, p = 0.296). In the assessment of the regional renal function of treated kidney, a statistically significant decrease in the functional renal volume was revealed at the part which underwent PCNL procedure (91cc +/- 30cc vs 82cc +/- 27cc; t = 2.64, p = 0.013). Regarding percent of injected dose per ml. of renal tissue, no statistically significant difference was found between the part of treated kidney, which underwent PCNL and non-affected area of the same kidney (0.049 +/- 0.02 vs 0.05 +/- 0.02; t = 0.693, p = 0.494). The function of contralateral kidney remained unchanged (13.4% +/- 5.2% vs 13.6% +/- 4.8%; t = 0.68, p = 0.5). Function volume, neither total percent uptake, nor percent of injected dose per ml. of renal tissue were reduced significantly. Further studies with long term follow-up of treated kidney are required.
本研究旨在通过定量单光子发射计算机断层扫描（SPECT）测量肾脏对锝-二巯基丁二酸（DMSA）的摄取量（QDMSA），定量研究经皮肾镜取石术（PCNL）对整体和局部肾功能的影响。
对79例行PCNL的肾结石患者进行序贯QDMSA检查。其中男性42例（53%），女性37例（47%），平均年龄47±16岁。初始研究在PCNL手术前进行，随访研究在PCNL术后1.5 - 24个月进行。在79例患者中的60例（76%）中，PCNL采用上极或下极入路，分别计算手术侧肾脏患侧和未患侧的局部肾功能。
PCNL手术前后患侧肾脏的摄取量无统计学显著差异（11.9%±5%对11.6%±5%；t = 0.9，p = 0.368）。患侧肾脏的总肾功能体积略有下降，从235cc±62cc降至224cc±59cc（t = 2.7；p = 0.011）。患侧肾脏每毫升肾组织的注射剂量百分比在统计学上未受影响（0.051±0.02对0.053±0.02；t = 0.86，p = 0.296）。在评估患侧肾脏的局部肾功能时，PCNL手术部位的功能性肾体积有统计学显著下降（91cc±30cc对82cc±27cc；t = 2.64，p = 0.013）。关于每毫升肾组织的注射剂量百分比，PCNL手术部位与同一肾脏未受影响区域之间未发现统计学显著差异（0.049±0.02对0.05±0.02；t = 0.693，p = 0.494）。对侧肾脏功能保持不变（13.4%±5.2%对13.6%±4.8%；t = 0.68，p = 0.5）。功能体积、总摄取百分比或每毫升肾组织的注射剂量百分比均未显著降低。需要对患侧肾脏进行长期随访的进一步研究。
