[肾结石手术对肾功能的影响——用99mTc-DMSA肾闪烁显像评估肾功能]

[Influences of renal stone surgeries on renal function--evaluation of renal function with 99mTc-DMSA renal scintigraphy].

作者信息

Katayama Y

机构信息

Department of Urology, Niigata University School of Medicine.

出版信息

Nihon Hinyokika Gakkai Zasshi. 1991 Oct;82(10):1588-93. doi: 10.5980/jpnjurol1989.82.1588.

DOI:10.5980/jpnjurol1989.82.1588

PMID:1663182

Abstract

From 1984 to 1990, 99mTc-DMSA renal scintigraphy was performed before and after nephrolithotomy (15 cases), pyelolithotomy (15 cases), percutaneous nephrolithotripsy (PNL: 15 cases) and extracorporeal shock wave lithotripsy (ESWL: 16 cases, 17 kidneys) in order to evaluate of influences of renal stone surgeries on split renal function. DMSA renal uptake change ratio of treated kidneys of nephrolithotomy (-24.94 +/- 5.60%) was significantly lower than that of PNL (-0.06 +/- 3.92%), pyelolithotomy (-4.08 +/- 4.79%) (p less than 0.01) and ESWL (-7.72 +/- 3.87%) (p less than 0.05). The average change ratios of contralateral kidneys were as follows: PNL 4.80 +/- 4.21% nephrolithotomy 4.67 +/- 4.73%, pyelolithotomy -1.46 +/- 5.39% and ESWL -2.02 +/- 4.44%. One to 3 weeks after PNL, the cold area on the renal image was found in 10 (66.7%) of 15 cases. In cases of ESWL, DMSA renal uptake decreased even 4-10 weeks (mean 7 weeks) after treatment. In conclusion, possivility of deterioration of renal function after ESWL was suggested.

摘要

1984年至1990年期间，对15例接受肾切开取石术、15例接受肾盂切开取石术、15例接受经皮肾镜碎石术（PNL）以及16例（17个肾脏）接受体外冲击波碎石术（ESWL）的患者，在手术前后进行了99mTc - DMSA肾闪烁扫描，以评估肾结石手术对分肾功能的影响。肾切开取石术治疗侧肾脏的DMSA肾摄取变化率（-24.94±5.60%）显著低于经皮肾镜碎石术（-0.06±3.92%）、肾盂切开取石术（-4.08±4.79%）（p＜0.01）以及体外冲击波碎石术（-7.72±3.87%）（p＜0.05）。对侧肾脏的平均变化率如下：经皮肾镜碎石术为4.80±4.21%，肾切开取石术为4.67±4.73%，肾盂切开取石术为-1.46±5.39%，体外冲击波碎石术为-2.02±4.44%。经皮肾镜碎石术后1至3周，15例中有10例（66.7%）在肾脏图像上发现冷区。在体外冲击波碎石术病例中，治疗后4至10周（平均7周）DMSA肾摄取仍下降。总之，提示体外冲击波碎石术后存在肾功能恶化的可能性。