CAJ | 학술논문

目的探讨99Tcm-DTPA利尿肾动态显像皮质通过时间(pTT)作为预测肾盂输尿管连接部狭窄(UPJO)离断式肾盂成形术后肾功能改善指标的可行性.方法回顾性分析47例[男37例,女10例,年龄(29.7±10.8)岁]单侧UPJO患者临床情况及手术前后99Tcm-DTPA利尿肾动态显像,记录患者的年龄、性别、患肾位置、梗阻类型、手术方式、相对肾功能[RRF(患肾放射性摄取占总肾的百分比)]以及PTT,评价不同因素或指标对术后患肾RRF改善率(术后与术前RRF差值)的影响.符合以下情况之一即为PTT延迟:(1)在第2～7帧慢动态影像上,积水肾盂内未见放射性；(2)在第2～9帧慢动态影像上,肾皮质放射性无变化,肾大小、形态变化不明显；(3)肾皮质放射性持续增加；(4)自慢动态第2帧影像始,肾皮质放射性清除较对侧正常肾慢.采用配对t检验、Kruskal-Wallis及MannWhitney秩和检验和Pearson相关分析对数据进行统计学分析.结果术后患肾RRF高于术前,分别为(40.70±13.30)％、(44.96±12.60)％,t=4.19,P＜0.01.PTT延迟组(16例)RRF改善率显著高于PTT正常组(27例),分别为(11.69±6.52)％、(0.48±2.98)％,Z=-5.13,P＜0.01；4例患肾PTT不能明确判断延迟或正常.术前不同RRF(＜40％与≥40％)、梗阻类型(机械性与非机械性)、患肾位置(左与右)、手术方式(开放手术与腹腔镜手术)以及性别(男与女)组间的患肾RRF改善率差异均无统计学意义(Z=-1.93～ 1.25,均P＞0.05).患肾RRF改善率与患者年龄之间未见有统计学意义的相关性(r=0.01,P＞0.05).结论 99Tcm-DTPA利尿肾动态显像PTT延迟是预测UPJO患者术后肾功能改善的唯一有效指标.
목적 탐토99Tcm-DTPA이뇨신동태현상피질통과시간(pTT)작위예측신우수뇨관련접부협착(UPJO)리단식신우성형술후신공능개선지표적가행성.방법 회고성분석47례[남37례,녀10례,년령(29.7±10.8)세]단측UPJO환자림상정황급수술전후99Tcm-DTPA이뇨신동태현상,기록환자적년령、성별、환신위치、경조류형、수술방식、상대신공능[RRF(환신방사성섭취점총신적백분비)]이급PTT,평개불동인소혹지표대술후환신RRF개선솔(술후여술전RRF차치)적영향.부합이하정황지일즉위PTT연지:(1)재제2～7정만동태영상상,적수신우내미견방사성；(2)재제2～9정만동태영상상,신피질방사성무변화,신대소、형태변화불명현；(3)신피질방사성지속증가；(4)자만동태제2정영상시,신피질방사성청제교대측정상신만.채용배대t검험、Kruskal-Wallis급MannWhitney질화검험화Pearson상관분석대수거진행통계학분석.결과 술후환신RRF고우술전,분별위(40.70±13.30)％、(44.96±12.60)％,t=4.19,P＜0.01.PTT연지조(16례)RRF개선솔현저고우PTT정상조(27례),분별위(11.69±6.52)％、(0.48±2.98)％,Z=-5.13,P＜0.01；4례환신PTT불능명학판단연지혹정상.술전불동RRF(＜40％여≥40％)、경조류형(궤계성여비궤계성)、환신위치(좌여우)、수술방식(개방수술여복강경수술)이급성별(남여녀)조간적환신RRF개선솔차이균무통계학의의(Z=-1.93～ 1.25,균P＞0.05).환신RRF개선솔여환자년령지간미견유통계학의의적상관성(r=0.01,P＞0.05).결론 99Tcm-DTPA이뇨신동태현상PTT연지시예측UPJO환자술후신공능개선적유일유효지표.
Objective To evaluate the usefulness of delayed parenchymal transit time (PTT) on 99TcmDTPA diuretic renography as a predictor for functional improvement after Anderson-Hynes dismembered pyeloplasty in patients with ureteropelvic junction obstruction (UPJO).Methods Forty-seven patients (37males,10 females,age (29.7± 10.8) years) with unilateral U PJO were retrospectively analyzed.All patients underwent 99Tcm-DTPA diuretic renography before and after the surgery.Patient age,sex,UPJO location,surgical methods,relative renal function (RRF) of the diseased kidney (uptake ratio of UPJO kidney to both kidneys),and PTT were recorded.Delayed PTT was defined as having one of the following criteria: (1) photopenic pelvis between the second and seventh frame; (2) relatively stable tracer distribution within the kidney between the second to ninth frame with nearly unchanged kidney shape and size; (3) ever increasing activity in the parenchyma; (4) slower clearance from the parenchyma into the pelvis since the second frame compared with the contralateral healthy kidney.The relationship between the above-mentioned factors and RRF improvement (RRFpvst-surgery,-RRFpre-sugery) was analyzed.Paired t test,Kruskal-Wallis and Mann-Whitney rank sum tests and Pearson correlation analysis were used.Results The average RRF of pre-and post-surgery was (40.70± 13.30) ％ and (44.96 ± 12.60) ％,respectively (t =4.19,P ＜ 0.01).RRF improvement between the delayed group (n=16) and normal timely PTT group (n=27) was significantly different: ((11.69±6.52) ％ vs (0.48±2.98) ％,Z=-5.13,P＜0.01).The assessment of delayed or normal PTT could not be determined in 4 patients.No statistically significant differences of RRF improvement were found between pre-surgery RRF ＜ 40％ and RRF ≥ 40％ groups,between left and right UPJO groups,between open surgery and laparoscope groups,between male and female patients (Z =-1.93 to 1.25,all P＞0.05).There was no significant correlation between RRF improvement and patient age (r =0.01,P＞0.05).Conclusion Delayed PTT on 99Tcm-DTPA diuretic renography might be the predictor for functional improvement post surgery in UPJO patients.