| Objective: To investigate the effect of one-step dilation to establish percutaneous renal micro-access on kidney injury with hydronephrosis,so as to provide a guideline for the clinical application of one-step dilatation in PCNL.Methods:1.Nine adult healthy male Guizhou miniature pigs,the cannula was selected to establish reversible partial unilateral ureteral obstruction model,left kidney of which had been removed,were randomly divided into three groups: S group,CPUUO group and RPUUO group,three in each group.In the RPUUO group and the CPUUO group,right ureteral obstruction was caused by cannula.On the 14 th day after operation,the obstruction was relieved in the RPUUO group and not in the CPUUO group.The SCr and BUN reflect the changes in renal function,the changes in DRCSS was observed by ultrasound scanning,and the changes in kidney renal pathological damage through HE staining.2.Twenty-four healthy adult male miniature pigs,provided by the Animal Research Institute of Guizhou University of Traditional Chinese Medicine,were used to establish bilateral hydronephrosis models by using cannula method to cause the partial ureteral obstruction,they were randomly divided into micro-access group and standard-access group.According to different dilation methods in micro-access group,they were randomly divided into one-step dilation group(group O)and multi-step dilation group(group M).According to different dilation methods in standard-access group,they were randomly divided into one-step dilation group(group C)and multi-step dilation group(group T),the SCr,BUN and Cys C reflect the changes in renal function,Methylene blue solution was injected into the left ureter to mark the channel of left renal laceration and the volume of it was measured.The right kidney was stained with HE and Masson,and the scar size of micro-access was calculated.Results:1.Reversible partial unilateral ureteral obstruction model The SCr and BUN of the RPUUO group increased significantly on the 3rd day after operation,reached the highest value on the 14 th day,and recovered on the 28 th day.The SCr and BUN of the RPUUO group was higher than those of the S group on the 7th and 14 th day after operation SCr(p ?<0.05),BUN(p ?<0.05).On the 28 th day,the SCr and BUN of the RPUUO group was lower than those of CPUUO group SCr(p ?<0.05),BUN(p ?<0.05).The DRCSS of the RPUUO group increased significantly on the 7th day after operation,reached the highest value on the 14 th day,and recovered on the 28 th day.The DRCSS of the RPUUO group was higher than that of the S group on the 7th and14 th day after operation(p ?<0.05).On the 28 th day,the DRCSS of the RPUUO group was lower than that of CPUUO group(p ? <0.05).No obvious renal pathological changes were found in the S group.In the CPUUO group,the renal tissue structure was severely abnormal,following the number of glomeruli significantly reduced,the large number of renal tubules atrophied and disappeared,the remaining renal tubules significantly expanded,and a large number of fibroblasts proliferated and inflammatory cells infiltrated in the renal interstitium.In the RPUUO group,the glomerular changes were not obvious,the renal tubules were slightly dilated,and there was no obvious inflammatory cell infiltration in the renal interstitium.2.The access-establishing time in group O was less than group M(p ?<0.05).The duration of gross hematuria in group O was not significantly different from that in group M(P?>0.05).There was no significant difference in SCr,BUN,Cys C between group O and group M on the 7th,14 th,30th and 90 th day after operation(P?>0.05).Immediately after operation,the volume of left real laceration in group O was equal to group M(P?>0.05),and the percentage of left renal laceration volume in group O was also equal to group M(P?>0.05).On the 90 th day after operation,the scar volume of right kidney in group O was same to group M(P ? >0.05),and the scar volume percentage was same to group M(P?>0.05).The access-establishing time in group C was less than group T(P<0.05).The duration of gross hematuria in group C was significantly different from that in group T(P < 0.05).There was no significant difference in SCr,BUN and Cys C between group C and group T on the 7th,14 th,30th and 90 th day after operation(P?>0.05).Immediately after operation,the volume of left real laceration in group C was equal to group T(P?>0.05),and the percentage of left renal laceration volume in group C was also equal to group T(P?>0.05).On the 90 th day after operation,the scar volume of right kidney in group C was same to group M(P?>0.05),and the scar volume percentage was same to group T(P?>0.05).Conclusion:1.The model of RPUUO was established by cannula in miniature pigs,which is safe and feasible.2.Compared with the multi-step dilation,the one-step dilation method to establish percutaneous renal micro-access in hydronephrosis kidney has the advantages of less time,equal safety,and no more kidney damage,which is worthy being widely used in clinical work.3.Compared with the multi-step dilation,the one-step dilation method to establish percutaneous renal standard-access in hydronephrosis kidney has aggravates the hematuria and it should be carefully selected clinically. |
