Kiliç Süleyman, Oğuz Fatih, Kahraman Bayram, Altunoluk Bülent, Ergin Hüseyin
Department of Urology, Turgut Ozal Medical Center, Inonu University School of Medicine, Malatya, Turkey.
J Endourol. 2008 Apr;22(4):615-21. doi: 10.1089/end.2007.0232.
To evaluate the kidneys with color Doppler ultrasonography (CDUS) to determine whether percutaneous nephrolithotomy (PNL) causes renal parenchymal damage.
In 24 patients who underwent unilateral PNL with single renal pole access, cortical thickness, echogenicity, and resistive index (RI) were measured in each pole of the operated and contralateral kidney separately before and at postoperative day (POD) 1, and at 3, 6, and 12 months after PNL.
The mean age of the patients was 36.67 +/- 14.68 years. The serum creatinine level increased significantly immediately after PNL but diminished to the preoperative level at POD 1. Changes in serum blood urea nitrogen and electrolyte levels were insignificant. Mean cortical thickness increased significantly in the access pole and contralateral kidney and insignificantly in the nonaffected pole. No statistically significant change was recorded in parenchymal echogenicitiy. Statistically significant differences in cortical thickness between the access pole and the contralateral kidney and between the nonaffected pole and the contralateral kidney disappeared 3 months later. Differences in mean cortical thickness between the access pole and the nonaffected pole were insignificant at all examination periods. Echogenicity was greater in the access pole and the nonaffected pole than in the contralateral kidney only at POD 1. No significant difference was noted in the echogenicity between the access pole and the nonaffected pole. Mean RIs were lower than the universally accepted pathologic RI level (0.70) at all periods. There was no statistically significant difference between the mean RI values of the access pole, nonaffected pole, and contralateral kidney.
PNL does not cause obvious renal dysfunction and significant parenchymal scarring, which is indicated by the decrease in cortical thickness and increases in cortical echogenicity and intrarenal RI.
采用彩色多普勒超声（CDUS）评估肾脏，以确定经皮肾镜取石术（PNL）是否会导致肾实质损伤。
对24例行单侧单肾极入路PNL的患者，分别在手术前、术后第1天以及PNL术后3个月、6个月和12个月，测量手术侧肾脏和对侧肾脏各极的皮质厚度、回声及阻力指数（RI）。
患者的平均年龄为36.67±14.68岁。PNL术后血清肌酐水平立即显著升高，但在术后第1天降至术前水平。血清尿素氮和电解质水平变化不显著。入路极和对侧肾脏的平均皮质厚度显著增加，未受影响极的增加不显著。肾实质回声未见统计学显著变化。入路极与对侧肾脏之间以及未受影响极与对侧肾脏之间的皮质厚度差异在3个月后消失。在所有检查时期，入路极与未受影响极之间的平均皮质厚度差异均不显著。仅在术后第1天，入路极和未受影响极的回声高于对侧肾脏。入路极与未受影响极之间的回声无显著差异。所有时期的平均RI均低于普遍认可的病理RI水平（0.70）。入路极、未受影响极和对侧肾脏的平均RI值之间无统计学显著差异。
PNL不会导致明显的肾功能障碍和显著的实质瘢痕形成，这可通过皮质厚度的降低、皮质回声的增加以及肾内RI的升高得以体现。
