输尿管部分梗阻对五指山小型猪肾脏功能及形态影响的实验研究

发布时间：2018-03-21 20:44

本文选题：单侧输尿管部分梗阻　切入点：猪　出处：《中南大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：采用输尿管部分结扎法建立五指山小型猪单侧输尿管部分梗阻(PUUO)模型；测定输尿管部分梗阻后肾脏的形态及血流动力学参数,分析肾动脉血流阻力指数(RI)对梗阻肾的诊断价值和对梗阻肾功能的预测价值；观察单侧输尿管部分梗阻及梗阻解除后的肾小球滤过率(GFR)及肾有效血浆流量(ERPF)变化规律,分析GFR、ERPF预测梗阻肾功能可恢复性的价值,为临床治疗提供理论依据。方法：15头健康的10至12月龄五指山小型猪,雌雄不限。术前均行彩色多普勒超声检查及单光子正电子发射计算机体层成像(SPECT)肾功能显像检查,测定肾孟的最大前后径(APD)、肾皮质厚度(RCT)、RI、收缩期峰值血流速度(PSV)、舒张末血流速度(EDV)、 GFR、ERPF等数据作为正常对照。然后随机选取9头五指山猪用输尿管部分结扎法制作左侧输尿管部分梗阻模型,梗阻成功的8头猪分别在梗阻后1、2、4周及梗阻解除后1、2、4周测定相应指标。另6头作假手术对照,术后1周后进行检查。根据测定值计算双侧肾脏动脉RI差值(△RJ)和双侧RI比率(RIR)。术后各时间点各指标结果均与术前正常对照值作比较以了解其变化规律。结果：假手术组手术前后各指标比较均无统计学差异。输尿管部分梗阻后肾盂APD随梗阻时间延长进行性增加,而RCT则逐渐减少。梗阻1、2、4周的APD均显著高于正常对照值,而RCT在梗阻1、2、4周后显著小于术前正常对照值(P0.01)。梗阻解除后,APD明显减小,与术前正常对照值无明显差异(p0.05),RCT有略微升高,但仍显著低于正常对照值(p0.01)。多普勒超声检查示梗阻后肾动脉及肾内动脉PSV及EDV均逐渐降低,梗阻后各时间点均显著低于术前正常对照值(P0.01)。RI均逐渐增高,不同梗阻时间点肾动脉及肾内动脉的RI值均显著高于术前正常对照值(p0.01)。梗阻解除恢复4周后,肾动脉及肾内动脉的RI值与正常对照值相当(P0.05)。而PSV和EDV恢复缓慢,梗阻恢复4周后仍显著低于对照组(P0.01)。若以RI≥0.7,△RI≥0.1, RIR≥1.10为标准判定梗阻,则肾动脉和肾内动脉RI诊断梗阻的总准确率分别为0、20.8%、66.7%和0、16.7%、29.2%。梗阻1、2、4周后,梗阻肾GFR显著低于正常对照值,其中第1周下降的幅度最大,达23.2%。梗阻解除后梗阻肾GFR有所上升,但与术前正常对照值仍有差异(p0.01)。ERPF的变化趋势跟GFR一致。总肾GFR及ERPF与术前正常对照值相比一直无统计学差异(P0.05)。结论：1.采用输尿管部分结扎法可成功建立五指山小型猪单侧输尿管部分梗阻(PUUO)模型。2.输尿管部分梗阻可引起梗阻肾脏血流速度明显减慢,PSV、EDV等血流动力学参数的改变可反应肾脏功能状态,对肾功能的评估有一定的意义。单纯依赖RI值来判断输尿管部分梗阻存在一定局限性,对比双侧肾脏RI值可提高其诊断的准确率。3.输尿管部分梗阻后GFR、ERPF降低以早期最为显著,梗阻解除后有所上升,梗阻期间右肾起到了较好的代偿作用。当梗阻肾GFR、ERPF下降至50%左右时,在梗阻解除后其功能能够得到较好恢复,但能否完全恢复尚需后续的实验研究。图19幅,表20个,参考文献52篇。
[Abstract]:Objective: to establish the Five Fingers Group miniature pigs with partial unilateral ureter obstruction by partial ureteral ligation (PUUO) model; morphological and hemodynamic parameters in the kidney were partial ureter obstruction after analysis of renal artery resistance index (RI) value in diagnosis of ureteral obstruction and obstruction of renal function prediction; observation of partial unilateral ureter obstruction and obstruction after the lifting of the glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) changes, analysis of GFR, ERPF prediction of obstructive renal function recovery value, provide a theoretical basis for clinical treatment.
Methods: 15 healthy 10 to 12 month old Five Fingers Group mini pigs, male and female. All patients underwent preoperative color Doppler ultrasound and single photon positron emission tomography (SPECT) imaging of renal function, determination of renal pelvis the largest anteroposterior diameter (APD), renal cortical thickness (RCT), RI, systolic peak the blood flow velocity (PSV), end diastolic blood flow velocity (EDV), GFR, ERPF and other data as controls. Then randomly selected 9 head pig production PUUO left Five Fingers Group model with partial ureteral ligation, the corresponding index determination 1,2,4 weeks obstruction successful 8 pigs respectively in 1,2,4 weeks after obstruction and obstruction after the other 6 head. Sham operation control, postoperative 1 weeks after the examination. According to the measured value calculation of bilateral renal artery RI difference (delta RJ) and bilateral RI ratio (RIR). After the operation of each index at each time point and the results of preoperative normal value as compared to understand it Change the law.
Results: after sham operation group of each index were no statistically significant difference. The renal pelvis after unilateral partial ureteral obstruction APD with prolonged obstruction was increased, while RCT decreased. Obstruction 1,2,4 weeks of APD were significantly higher than the normal value, and RCT in obstruction after 1,2,4 weeks before surgery was significantly lower than the normal value (P0.01). After the relief of obstruction, APD decreased, and the preoperative normal value had no significant difference (P0.05), RCT slightly higher, but still significantly lower than the normal value (P0.01). Doppler ultrasound examination showed obstruction after artery PSV and EDV renal artery and renal obstruction were gradually reduced, after each time point the preoperative value was significantly lower than that of normal control (P0.01) of.RI was gradually increased in different time point, obstruction of renal artery and renal artery RI values were significantly higher than the preoperative normal value (P0.01). Obstruction recovery after 4 weeks, the renal artery and renal artery RI value and normal The control value (P0.05). PSV and EDV recovered slowly, obstruction recovery after 4 weeks was significantly lower than that of control group (P0.01). If RI = 0.7, RI > 0.1, RIR = 1.10 as the standard to determine the total obstruction, the accurate rate of renal artery and renal artery obstruction in RI diagnosis were 0,20.8% 66.7% and 0,16.7%, 29.2%. obstruction 1,2,4 weeks after renal GFR was significantly lower than the normal value in the first week, the largest decrease of 23.2%. after relieving obstruction of renal GFR increased, but with the preoperative normal value still has the difference (P0.01) of.ERPF with GFR. The change trend of total kidney GFR and ERPF with the preoperative normal value has been compared to no significant difference (P0.05).
Conclusion: 1. using partial ureteral ligation can be successfully established in Five Fingers Group in miniature pigs with partial unilateral ureter obstruction (PUUO) model of.2. partial ureter obstruction can cause obstruction of renal blood flow slowed down, PSV, EDV and other hemodynamic parameters change can reflect the renal function state, has a certain significance for the evaluation of renal function. Simply rely on RI to determine the value of partial ureteral obstruction has certain limitation, comparison of bilateral renal RI value can improve the diagnostic accuracy of.3. GFR ERPF after partial ureter obstruction, early to reduce the most significant, the relief of the obstruction after rise, obstruction during the right kidney played a better compensatory action. When renal GFR, ERPF decreased to around 50%, in its function after the relief of obstruction can get better recovery, but can still need to complete recovery following experiments. 19 charts, 20 tables, 52 references.

【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692

【参考文献】