腎局所冷却による腎切石術について

Abstract

Effectiveness of regional renal hypothermia was determined from the change in serum and urinary enzyme activities in experimental renal ischemia and in clinical ischemia of patients with renal calculi. 1) Twenty-eight dogs were used for the experimental renal ischemia. All dogs had right nephrectomy 4 weeks before the renal ischemic experiment. The dogs were allocated into four groups according to duration of ischemia and with or without hypothermic renal perfusion. Serum and urinary lactic dehydrogenase (LDH) activities showed consistent elevation following renal ischemia in both the dogs that had received hypothermic renal perfusion and in those that had not. Serum LDH isozyme index was elevated in dogs that had not received hypothermic renal perfusion during renal ischemia. Serum and urinary alkaline phosphatase (AI-p) and glutamic oxaloacetic transaminase (GOT) activities were elevated immediately after ischemia and decreased day by day. However, serum and urinary leucine aminopeptidase (LAP) activities did not change after renal ischemia in the dogs that had received hypothermic renal perfusion or in those that had not. Histologically, severe degenerative changes of the renal parenchyma were observed in dogs when ischemia was prolonged long without hypothermic renal perfusion. 2) Thirty-six patients with renal calculi had nephrotomy. In situ hypothermic renal perfusion was performed in 9 of the cases and it was not used in the other cases. Serum and urinary enzyme activities were studied in these two groups of patients following renal ischemia. Serum LDH activity was elevated after operation in all the paients who had in situ hypothermic renal perfusion and those who had not. Urinary LDH activity was elevated after ischemia in patients who had had in situ hypothermic renal perfusion. Serum and urinary LDH isozyme indexes were elevated after ischemia in patients who did not have hypothermic renal perfusion. However, these LDH isozyme indexes did not elevate after ischemia in patients who had had in situ hypothermic renal perfusion. Urinary Al-p and LAP activities were elevated immediately after operation and decreased day by day in all patients. Serum and urinary LDH isozyme indexes were helpful for the evaluation on disturbance of the renal function after ischemia. Regional hyothermic renal perfusion is useful for preservation of renal function after an operation using renal ischemia.