Gaussin G, Oliveux A, Scheiben C, Bollack C
J Urol (Paris). 1980;86(4):245-55.
The authors report a study of 37 kidneys in 30 patients with staghorn calculi undergoing isotopic investigation of renal function by sequential scintigraphy and isotopic nephrogram by gamma-camera. 7 of the patients had bilateral staghorn calculi. Tracers used: Hippuran labelled with I131 and DPTA labelled with Technetium 99 m. 62% of kidneys poorly tolerated their staghorn calculus as shown by severe impairment of the isotopic nephrogram involving the uptake phase. Amongst the 20 cases of unilateral lithiasis, a nephrectomy was performed whenever the functional value was less than 20% normal (7 kidneys). Twelve stones were removed with conservation of the kidney. It should be noted that with renal function greater than 70% normal, the thickness of the renal parenchyma as assessed by IVU is never less by more than 1/2 cm that of the contralateral kidney. In the group, 11 patients underwent postoperative urography and scintigraphy with a mean follow up of 4 years. All extractions of calculi by pyelotomy with or without a small nephrotomy benefited initially impaired kidneys. By contrast, in 5 kidneys where a large nephrotomy was made, there was a gain in function in only one. 1 remained stationary and the others lost respectively 20, 30 and 100% of their function. Correlation was good with other methods of split renal function studies (IVU and renal arteriography). Of essential importance is the fact that the irradiation associated with these isotopic investigations is 20 to 50 times less than that of IVU. Isotopic investigation is thus a good method for the assessment of changes in renal function after surgery for staghorn calculus.
作者报告了一项针对30例鹿角形结石患者的37个肾脏的研究，这些患者接受了通过连续闪烁扫描进行的肾功能同位素检查以及通过γ相机进行的同位素肾图检查。其中7例患者患有双侧鹿角形结石。使用的示踪剂：用碘131标记的马尿酸钠和用锝99m标记的二巯基丁二酸。同位素肾图的摄取期严重受损表明，62%的肾脏对鹿角形结石耐受性差。在20例单侧结石病例中，只要功能值低于正常的20%（7个肾脏），就进行肾切除术。12例结石被取出，肾脏得以保留。需要注意的是，当肾功能大于正常的70%时，通过静脉肾盂造影评估的肾实质厚度与对侧肾脏相比，减少从不超过0.5厘米。该组中有11例患者术后接受了尿路造影和闪烁扫描，平均随访4年。所有通过肾盂切开术（无论是否进行小肾切开术）取出结石的手术，最初受损的肾脏都从中受益。相比之下，在5例进行了大肾切开术的肾脏中，只有1例功能有所改善。1例保持稳定，其他分别丧失了20%、30%和100%的功能。与其他分肾功能研究方法（静脉肾盂造影和肾动脉造影）的相关性良好。至关重要的是，与这些同位素检查相关的辐射比静脉肾盂造影少20至50倍。因此，同位素检查是评估鹿角形结石手术后肾功能变化的一种好方法。
