CAJ | 학술논문

目的探讨高强度聚焦超声(HIFU)治疗乳糜尿的疗效和安全性. 方法回顾性分析2000年1月至2011年6月收治的131例乳糜尿患者的临床资料,男59例,女72例.年龄23～83岁,平均59岁.其中左侧74例,右侧51例,双侧6例.合并乳糜血尿47例.肾蒂周围淋巴管结扎术后复发22例,腹腔镜下肾蒂淋巴管结扎术后复发5例,硝酸银肾盂灌注后复发1例.采用HIFU对患侧肾蒂及输尿管上段进行热辐照,分2～3个治疗层面,隔天1次,由深层至浅层进行,直至将患侧肾蒂及输尿管上段完全覆盖.HIFU的焦域大小为4 mm×4 mm×7 mm,超声波发射功率800～1100W,单元发射时间0.15 s,占空时间0.18 s,单点发射的总次数为50次,治疗全过程由计算机实时监控.治疗后记录并分析患者乳糜尿治愈时间、治疗前后肾蒂彩色多普勒超声及肾功能检查结果,血、尿常规检查数据等. 结果本组131例中,随防116例,失访15例,随防时间1～5年.有效96例(82.8％),其中治愈85例(73.3％),改善11例(9.5％)；无效20例(17.2％).乳糜尿治愈时间:1周67例(69.8％),2周13例(13.5％),4周11例(11.5％),8周5例(7.5％).66例彩色多普勒超声及肾功能检查示患侧肾脏体积、肾动脉内径、最大血流速度(Vmax)和阻力指数(RI)、肾静脉内径和血流速度、血清SCr、BUN等结果均正常,与治疗前比较差异无统计学意义(P＞0.05)；血、尿常规检查结果与治疗前比较差异有统计学意义(P＜0.05)；131例患者在治疗过程中生命体征平稳,未出现严重并发症. 结论 HIFU是一种治疗乳糜尿安全、有效的新方法.
목적 탐토고강도취초초성(HIFU)치료유미뇨적료효화안전성. 방법 회고성분석2000년1월지2011년6월수치적131례유미뇨환자적림상자료,남59례,녀72례.년령23～83세,평균59세.기중좌측74례,우측51례,쌍측6례.합병유미혈뇨47례.신체주위림파관결찰술후복발22례,복강경하신체림파관결찰술후복발5례,초산은신우관주후복발1례.채용HIFU대환측신체급수뇨관상단진행열복조,분2～3개치료층면,격천1차,유심층지천층진행,직지장환측신체급수뇨관상단완전복개.HIFU적초역대소위4 mm×4 mm×7 mm,초성파발사공솔800～1100W,단원발사시간0.15 s,점공시간0.18 s,단점발사적총차수위50차,치료전과정유계산궤실시감공.치료후기록병분석환자유미뇨치유시간、치료전후신체채색다보륵초성급신공능검사결과,혈、뇨상규검사수거등. 결과본조131례중,수방116례,실방15례,수방시간1～5년.유효96례(82.8％),기중치유85례(73.3％),개선11례(9.5％)；무효20례(17.2％).유미뇨치유시간:1주67례(69.8％),2주13례(13.5％),4주11례(11.5％),8주5례(7.5％).66례채색다보륵초성급신공능검사시환측신장체적、신동맥내경、최대혈류속도(Vmax)화조력지수(RI)、신정맥내경화혈류속도、혈청SCr、BUN등결과균정상,여치료전비교차이무통계학의의(P＞0.05)；혈、뇨상규검사결과여치료전비교차이유통계학의의(P＜0.05)；131례환자재치료과정중생명체정평은,미출현엄중병발증. 결론 HIFU시일충치료유미뇨안전、유효적신방법.
Objective To investigate the efficacy and safety of high-intensity focused ultrasound (HIFU) in treatment of chyluria.Methods Retrospectively analyze the HIFU-based treatment results of 131 patients with chyluria received treatment between Jan 2010 and Jun 2011.The patients' age ranges from 23 to 83 years old,with average 59.The patients consisted of 59 male patients and 72 female patients.74 cases were on the left side,right side 51 cases,6 cases bilateral.There were 47 patients with chylous hematuria,22 cases of recurrence after renal pedicle lymphatic vessel ligation,5 cases of recurrence after laparoscopic ligation of renal lymphatic,1 cases of recurrent pelvic perfusion after silver nitrate.The treatment was carried out according to the following procedure.The affected kidney pedicle and superior segment of ureter,after being divided into two or three irradiation layers,were irradiated daily from deep to superficial layers which completely cover the affected kidney pedicle and superior segment of ureter.The technical parameters of the treatment were:focal region size 4 mm×4 mm×7 mm,Ultrasonic power 800-1100 W,Unit firing time 0.15s,Dutv time 0.18s,Single point total transmit 50 times.The patients were followed up and re-examined within one to five years after treatment.Statistical analyses were conducted on the data of Color doppler ultrasound images on kidney pedicle and renal function tests before and after the treatment,blood routine examination and routine urianlysis.Results 116 patients were followed up and the treatment to 96 of them was deemed effective in which 85 patients completely recovered (73.3％ recovering rate) and 11 patients became better (9.5％).The other 20 patients (17.2％) was ineffective.With regard to the time required to cure chyluria,67 patients (69.8％) required one week,13 (13.5％) required two weeks,11 (11.5％) required four weeks,and 5 (7.5％) required five weeks.Results of color doppler ultrasound images on kidney pedicle and renal function tests were as follows.The volume of kidney,the inner diameter of renal artery,Vmax,RI,inner diameter and blood flow rate of renal vein and serum Cr,serum BUN had no significant difference before and after the treatment (P＞0.05).Results of anemia,hematuria,microscopic hematuria and urinary protein positive were significantly different from the before-treatment results (P＜0.05).During the treatment process,all patients had stable vital signs without serious complications.Conclusions Treating chyluria with HIFU could be a safe and effective method.