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目的:研究不同大小的气腹压力对于不同程度的积水肾的损伤作用。方法:采用输尿管套扎法建立左侧轻、重度肾积水模型,54只新西兰大白兔随机分为三组:假手术组(N组,n=18),轻度积水组(M组,n=18),重度积水组(S组,n=18),每组再分为三个亚组,依次给予0,10,15mmHg气腹加压处理1h。术后48h取左侧肾脏,HE染色观察肾小管形态结构,测肾组织内活性氧(ROS),丙二醛(MDA),乳酸(LD)含量,TUNEL检测细胞凋亡,取血清检测血肌酐(Cr),尿素氮(BUN)。结果:对于假手术组和轻度积水组,当压力为15mmHg时,肾损伤明显加重(肾小管结构明显改变,凋亡指数明显增加,ROS,MDA,LD含量明显升高);对于重度积水组,当压力为10mmHg时,肾脏损伤即明显加重。各小组Cr及BUN的差异无统计学意义。结论:重度积水的肾脏更容易受到气腹压造成的进一步损伤,行腹腔镜手术时应适当控制气腹压的大小。
Objective: To study the different sizes of pneumoperitoneum pressure for varying degrees of water kidney injury. Methods: The model of left mild hydronephrosis was established by ureteral ligation. Fifty-four New Zealand white rabbits were randomly divided into three groups: sham operation group (N group, n = 18), mild hydronephrosis group n = 18), and severe hydrocephalus group (group S, n = 18). Each group was further divided into three subgroups, followed by 0, 10 and 15 mmHg pneumoperitoneum for 1 hour. The left kidney was harvested at 48 hours after operation and the morphological changes of renal tubules were observed by HE staining. The content of reactive oxygen species (ROS), malondialdehyde (MDA) and lactate (LD) in renal tissue were measured. TUNEL was used to detect the apoptosis. Serum creatinine (Cr), urea nitrogen (BUN). Results: For the sham operation group and the mild hydrocephalus group, when the pressure was 15mmHg, the renal injury was obviously aggravated (the tubular structure changed obviously, the apoptotic index increased obviously, the content of ROS, MDA and LD increased obviously); for the severe product Water group, when the pressure is 10mmHg, kidney injury is significantly increased. The differences of Cr and BUN in each group were not statistically significant. Conclusion: Severe hydronephrosis of the kidneys is more likely to be caused by pneumoperitoneum further damage, laparoscopic surgery should be appropriate control of the size of the pneumoperitoneum.