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目的寻找一种术前评价积水肾功能的检测方法。方法对65例单侧上尿路梗阻行大剂量IVU延时造影至2h,均提示患肾“无功能”,B超均提示患肾重度积水,肾皮质菲薄,我们术前取其梗阻肾尿液测pH值,同时测定患者血清碳酸氢根浓度,以期评价术后肾功能的预后,所有保肾手术后3～6个月复查IVU,切肾手术后患肾均行病理检查判定评价结果。结果对梗阻肾尿液pH值小于7.1的43例,碳酸氢根浓度大于或等于24mmol/L者,肾功能均能恢复,则行保肾手术;对梗阻肾尿液pH值大于7.1的18例,碳酸氢根浓度小于24mmol/L者,则行切肾手术;对梗阻肾尿液pH值大于7.1的4例,碳酸氢根浓度大于24mmol/L者,肾功能有部分恢复,则行保肾手术。结论以往认为梗阻肾尿液pH值大于7.1则患肾功能均不能恢复,而我们重点对梗阻肾尿液pH值大于7.1者加上碳酸氢根浓度联合测定,即不单以肾脏的泌酸功能来判定其预后,而配以碳酸氢根重吸收功能,才能更好准确地判定其功能,这在对影像学检查判定“无功能肾“的病例,术前选择保肾或切肾具有重要的临床参考意义。
Objective To find a method for preoperative evaluation of hydronephrosis. Methods 65 cases of unilateral upper urinary tract obstruction high-dose IVU delayed angiography to 2h, all suggest that suffering from kidney “non-functional”, B-ultrasound are prompted to have severe hydronephrosis, renal cortex meager, we take preoperative obstructive kidney Urine was measured for pH value, and serum bicarbonate concentration was measured at the same time in order to evaluate the prognosis of postoperative renal function. IVU was performed 3 to 6 months after kidney preservation surgery, and renal allograft pathological examination was used to evaluate the results. Results obstructive renal urine pH value of less than 7.1 in 43 cases, bicarbonate concentration greater than or equal to 24mmol / L, renal function can recover, the line kidney surgery; obstruction of renal urine pH value greater than 7.1 in 18 cases , Bicarbonate concentration less than 24mmol / L, then cut kidney surgery; obstruction of renal urine pH value greater than 7.1 in 4 cases, bicarbonate concentration greater than 24mmol / L, renal function partially recovered, the line kidney surgery. Conclusion In the past that obstruction of renal urine pH value greater than 7.1 are unable to restore renal function, and we focus on obstructive renal urine pH value greater than 7.1 combined with the determination of bicarbonate concentration, that is, not only to the renal acid secretion function To determine the prognosis, and with bicarbonate reabsorption function, to better and accurately determine its function, which in the imaging examination to determine the “non-functional kidney” cases, preoperative choose kidney or cut the kidney has an important clinical D.