Chen K K, Chang L S, Chen M T, Yeh S H
Department of Surgery, Veterans General Hospital-Taipei, Taiwan, Republic of China.
J Urol. 1991 May;145(5):952-5. doi: 10.1016/s0022-5347(17)38498-7.
In an attempt to understand better the status of renal function after Kock pouch urinary diversion we conducted a prospective evaluation of renal function in 25 patients using the radionuclide 131iodine-hippurate. Studies were done before, and at 1 month and every 6 months for 30 months postoperatively. The radionuclide results were then compared to excretory urography and contrast study of the reservoir. Our renal function study included the determination of individual and total effective renal plasma flow (ml. per minute), the time to maximal radioactivity over the kidney (peak time in minutes) and a renogram. The mean total (both kidneys) effective renal plasma flow rates before (25 patients) and at month 1 (19), month 6 (14), month 12 (12), month 18 (6), month 24 (6) and month 30 (7) after operation were 385.5 +/- 112.2, 310.5 +/- 109.9, 362.7 +/- 69.2, 442.0 +/- 97.5, 468.2 +/- 82.5, 405.7 +/- 70.6 and 414.0 +/- 65.1, respectively. A comparison of individual and total effective renal plasma flow before and after operation revealed that only the change of the flow at each or both sides of the kidney before and at 1 month after the operation reached statistically significant differences, respectively (p less than 0.05, paired t test). Postoperatively 5 of 6 patients with hydronephrosis had abnormal peak time and a third segment on the renogram was performed on the corresponding side of the kidney. No reflux was noted on contrast study of the reservoir of any patient followed for up to 30 months. In conclusion, the radionuclide renal function evaluation showed a significant decrease of renal function 1 month after Kock pouch diversion, then it resumed and remained stable (neither improved nor deteriorated) for 30 months. Also the abnormal peak time and third segment on the renogram usually implicated a dilated upper urinary tract.
为了更好地了解Kock回肠膀胱术式尿液改道后的肾功能状况，我们对25例患者使用放射性核素131碘-马尿酸进行了肾功能的前瞻性评估。研究在术前、术后1个月以及术后30个月内每6个月进行一次。然后将放射性核素检查结果与排泄性尿路造影及储尿囊造影检查结果进行比较。我们的肾功能研究包括测定个体及总的有效肾血浆流量（每分钟毫升数）、肾脏放射性达到最大值的时间（峰值时间，分钟）以及肾图。术前（25例患者）及术后1个月（19例）、6个月（14例）、12个月（12例）、18个月（6例）、24个月（6例）和30个月（7例）时总的（双肾）有效肾血浆流量均值分别为385.5±112.2、310.5±109.9、362.7±69.2、442.0±97.5、468.2±82.5、405.7±70.6和414.0±65.1。术前与术后个体及总的有效肾血浆流量比较显示，仅手术前后各侧或双侧肾脏血浆流量的变化分别具有统计学显著差异（p＜0.05，配对t检验）。术后6例肾积水患者中有5例峰值时间异常，对相应侧肾脏进行了肾图第三段检查。在长达30个月的随访中，任何患者的储尿囊造影检查均未发现反流。总之，放射性核素肾功能评估显示，Kock回肠膀胱术式改道后1个月肾功能显著下降，随后恢复并在30个月内保持稳定（既未改善也未恶化）。此外，肾图上的异常峰值时间和第三段通常提示上尿路扩张。
