本文選題：單側(cè)輸尿管部分梗阻　切入點(diǎn)：豬　出處：《中南大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：采用輸尿管部分結(jié)扎法建立五指山小型豬單側(cè)輸尿管部分梗阻(PUUO)模型；測(cè)定輸尿管部分梗阻后腎臟的形態(tài)及血流動(dòng)力學(xué)參數(shù),分析腎動(dòng)脈血流阻力指數(shù)(RI)對(duì)梗阻腎的診斷價(jià)值和對(duì)梗阻腎功能的預(yù)測(cè)價(jià)值；觀察單側(cè)輸尿管部分梗阻及梗阻解除后的腎小球?yàn)V過(guò)率(GFR)及腎有效血漿流量(ERPF)變化規(guī)律,分析GFR、ERPF預(yù)測(cè)梗阻腎功能可恢復(fù)性的價(jià)值,為臨床治療提供理論依據(jù)。 方法：15頭健康的10至12月齡五指山小型豬,雌雄不限。術(shù)前均行彩色多普勒超聲檢查及單光子正電子發(fā)射計(jì)算機(jī)體層成像(SPECT)腎功能顯像檢查,測(cè)定腎孟的最大前后徑(APD)、腎皮質(zhì)厚度(RCT)、RI、收縮期峰值血流速度(PSV)、舒張末血流速度(EDV)、 GFR、ERPF等數(shù)據(jù)作為正常對(duì)照。然后隨機(jī)選取9頭五指山豬用輸尿管部分結(jié)扎法制作左側(cè)輸尿管部分梗阻模型,梗阻成功的8頭豬分別在梗阻后1、2、4周及梗阻解除后1、2、4周測(cè)定相應(yīng)指標(biāo)。另6頭作假手術(shù)對(duì)照,術(shù)后1周后進(jìn)行檢查。根據(jù)測(cè)定值計(jì)算雙側(cè)腎臟動(dòng)脈RI差值(△RJ)和雙側(cè)RI比率(RIR)。術(shù)后各時(shí)間點(diǎn)各指標(biāo)結(jié)果均與術(shù)前正常對(duì)照值作比較以了解其變化規(guī)律。 結(jié)果：假手術(shù)組手術(shù)前后各指標(biāo)比較均無(wú)統(tǒng)計(jì)學(xué)差異。輸尿管部分梗阻后腎盂APD隨梗阻時(shí)間延長(zhǎng)進(jìn)行性增加,而RCT則逐漸減少。梗阻1、2、4周的APD均顯著高于正常對(duì)照值,而RCT在梗阻1、2、4周后顯著小于術(shù)前正常對(duì)照值(P0.01)。梗阻解除后,APD明顯減小,與術(shù)前正常對(duì)照值無(wú)明顯差異(p0.05),RCT有略微升高,但仍顯著低于正常對(duì)照值(p0.01)。多普勒超聲檢查示梗阻后腎動(dòng)脈及腎內(nèi)動(dòng)脈PSV及EDV均逐漸降低,梗阻后各時(shí)間點(diǎn)均顯著低于術(shù)前正常對(duì)照值(P0.01)。RI均逐漸增高,不同梗阻時(shí)間點(diǎn)腎動(dòng)脈及腎內(nèi)動(dòng)脈的RI值均顯著高于術(shù)前正常對(duì)照值(p0.01)。梗阻解除恢復(fù)4周后,腎動(dòng)脈及腎內(nèi)動(dòng)脈的RI值與正常對(duì)照值相當(dāng)(P0.05)。而PSV和EDV恢復(fù)緩慢,梗阻恢復(fù)4周后仍顯著低于對(duì)照組(P0.01)。若以RI≥0.7,△RI≥0.1, RIR≥1.10為標(biāo)準(zhǔn)判定梗阻,則腎動(dòng)脈和腎內(nèi)動(dòng)脈RI診斷梗阻的總準(zhǔn)確率分別為0、20.8%、66.7%和0、16.7%、29.2%。梗阻1、2、4周后,梗阻腎GFR顯著低于正常對(duì)照值,其中第1周下降的幅度最大,達(dá)23.2%。梗阻解除后梗阻腎GFR有所上升,但與術(shù)前正常對(duì)照值仍有差異(p0.01)。ERPF的變化趨勢(shì)跟GFR一致�？偰IGFR及ERPF與術(shù)前正常對(duì)照值相比一直無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。 結(jié)論：1.采用輸尿管部分結(jié)扎法可成功建立五指山小型豬單側(cè)輸尿管部分梗阻(PUUO)模型。2.輸尿管部分梗阻可引起梗阻腎臟血流速度明顯減慢,PSV、EDV等血流動(dòng)力學(xué)參數(shù)的改變可反應(yīng)腎臟功能狀態(tài),對(duì)腎功能的評(píng)估有一定的意義。單純依賴RI值來(lái)判斷輸尿管部分梗阻存在一定局限性,對(duì)比雙側(cè)腎臟RI值可提高其診斷的準(zhǔn)確率。3.輸尿管部分梗阻后GFR、ERPF降低以早期最為顯著,梗阻解除后有所上升,梗阻期間右腎起到了較好的代償作用。當(dāng)梗阻腎GFR、ERPF下降至50%左右時(shí),在梗阻解除后其功能能夠得到較好恢復(fù),但能否完全恢復(fù)尚需后續(xù)的實(shí)驗(yàn)研究。圖19幅,表20個(gè),參考文獻(xiàn)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.

【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R692

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 楊述林;靳二輝;單同領(lǐng);張勇;牟玉蓮;馮書(shū)堂;彭克美;劉華珍;唐文花;李奎;;近交系五指山小型豬泌尿系統(tǒng)的解剖學(xué)研究[J];中國(guó)畜牧獸醫(yī);2007年10期

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