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目的:评估和比较不同穿刺路径、通道大小及扩张方法的肾实质损伤。方法:2019年3月至2019年12月，分别选取武汉大学人民医院21例人肾标本和42例猪肾标本建立经皮肾通道扩张损伤模型。采用形态学分析方法研究不同通道大小及扩张方法的肾实质损伤，设置8F、12F、16F-a、16F-b、20F-a、20F-b、24F-a、24F-b、30F-a及30F-b共10个实验组，其中a、b分别表示一步扩张和逐步扩张。采用组织病理学分析方法研究经正常肾锥体正中(A)、融合肾锥体一侧(B)、融合肾锥体正中(C)及肾柱(D)4种不同穿刺路径的肾实质损伤。总体比较采用双向方差分析，组间比较采用n t检验。n 结果:猪肾及人肾标本肾实质裂口平均表面积分别为3.42～51.63 mmn 2和2.68～43.53 mmn 2，平均最大直径分别为2.84～13.27 mm和2.47～12.74 mm。猪肾及人肾标本24F-a、30F-a及30F-b组裂口表面积均明显增加，差异有统计学意义(n t1＝3.988、11.125、8.096，n t2＝4.613、5.659、5.999，n P0.05)。路径A、B、C、D肾实质内动脉损伤程度的秩均值分别为35.5、48.2、59.5、65.8，总体差异有统计学意义(n χ2＝16.020，n P<0.01)，两两比较路径A、C及路径A、D之间差异有统计学意义(n χ2＝8.027、13.874，n P0.05)。n 结论:通道扩张超过24F可能会增加肾实质损伤的风险，一步扩张与逐步扩张比较肾实质损伤在16～24F差异无统计学意义，经肾柱及融合肾锥体正中穿刺会增加肾实质内血管损伤的风险。“,”Objective:To evaluate and compare injury of the renal parenchyma using different puncture paths, access sizes, and dilation methods.Methods:Between March 2019 and December 2019, 21 human kidney specimens (HK) and 42 pig kidney specimens (PK) from Renmin Hospital of Wuhan University were selected to establish kidney dilation injury models. Morphological methods were used to analyze renal parenchymal injury of different access sizes and dilation methods. We set 10 groups as follows: 8F, 12F, 16F-a, 16F-b, 20F-a, 20F-b, 24F-a, 24F-b, 30F-a and 30F-b. The a and b represented one-shot dilation and sequential dilation, respectively. Histopathological methods were used to analyze renal parenchymal injury when punctured through the center of the normal renal pyramid (A), one side of the fused renal pyramid (FRP) (B), center of the entire FRP (C) and renal column (D), respectively.Results:The mean dilation areas ranged from 3.42 to 51.63 mmn 2 in PK and 2.68 to 43.53 mmn 2 in HK. The mean dilation diameters ranged from 2.84 to 13.27 mm in PK and 2.47 to 12.74 mm in HK. The dilation areas of PK and HK were significantly increased in 24F-a, 30F-a and 30F-b (n t1=3.988, 11.125, 8.096, n t2=4.613, 5.659, 5.999, n P0.05). The mean ranks of the arterial injury degree in paths A (35.5), B (48.2), C (59.5) and D (65.8) gradually increased, and the difference was statistically significant (n χ2=16.020, n P<0.01). Significant differences were found between paths A and C, and between paths A and D (n χ2=8.027, 13.874, n P0.05).n Conclusion:The risk of renal parenchymal injury may increase when dilated over 24F. No significant difference was found in the parenchymal injury between one-shot and sequential dilation in 16-24F. The puncture through the renal column and the center of the entire FRP increases the risk of vascular injury in renal parenchyma.