论文部分内容阅读
目的建立肾盂内高压灌流的动物模型,观察肾盂内高压灌流对肾单位结构的影响,探讨经皮肾镜时肾盂内灌流的安全压力。方法建立活体猪的肾盂内高压灌流动物模型(n=10),在无加压灌流至40.00 kPa(1 kPa=7.5 mm Hg)高压灌流间,每6.67 kPa作为一个压力级别灌流10 m in,穿刺获取肾实质组织,分别在光镜(HE染色、六胺银染色)及透射电镜下观察各级压力梯度下肾小球、肾小囊及近曲肾小管的形态变化。结果肾盂内灌流压在6.67~20.00 kPa时,肾单位各结构保持完整;当肾盂内灌流压达到26.66 kPa,透射电镜下可见肾近曲小管上皮细胞细胞器扩张,胞质内空泡形成,微绒毛紊乱、脱落等细胞受损表现;当肾盂内灌流压达33.33~40.00 kPa,可观察到肾小囊基底膜断裂、肾小囊壁破裂,红细胞及蛋白质漏入肾小囊,近曲小管上皮细胞微绒毛脱落、胞质内大量空泡形成,细胞膜及细胞器膜破裂等结构损伤表现。结论肾盂内灌流压力超过26.66kPa可对肾单位造成结构破坏,进行经皮肾镜手术过程中,应注意保持肾盂内压不超过26.66 kPa,避免对肾单位造成结构破坏。
OBJECTIVE: To establish an animal model of intra-pyrenal hyperemic perfusion to observe the effect of intra-renal pyelonic perfusion on the structure of nephron and to explore the safety of peritoneal perfusion during percutaneous nephrolithotomy. Methods The animal model of intra-pyrenial hydronephrosis in vivo was established (n = 10). Perfusion was performed at a pressure of 6.67 kPa for 10 minutes in a pressure-free perfusion between 40 kPa (1 kPa = 7.5 mm Hg) The renal parenchyma tissue was obtained and the morphological changes of glomerular, renal capsule and proximal tubule were observed under light pressure (HE staining, hexamine silver staining) and transmission electron microscopy. Results When the intra-pelvic perfusion pressure was between 6.67 and 20.00 kPa, the structures of the nephrons remained intact. When the intra-pelvic perfusion pressure reached 26.66 kPa, the organelles in the proximal renal tubular epithelial cells were expanded, the cytoplasmic vacuoles and microvilli Disorder, loss and other cell damage performance; when the intra-renal pelvic irrigation pressure up to 33.33 ~ 40.00 kPa, we can observe the rupture of the basement membrane of the renal capsule, renal capsule rupture, red blood cells and protein leakage into the renal capsule, proximal tubule epithelial cells Microvilli shedding, a large number of vacuoles within the cytoplasm, cell membrane and organelle membrane rupture and other structural damage. Conclusion Intrarenal pelvic pressure over 26.66kPa can cause structural damage to the nephron. During percutaneous nephrolithotomy, the internal pelvic pressure should be maintained at no more than 26.66 kPa to avoid any structural damage to the nephron.