微创经皮肾穿刺取石术中肾盂内压变化的临床研究

The variation of renal pelvic pressure during minimally invasive percutaneous nephrolithotomy

目的探讨微创经皮肾穿刺取石（MPCNL）术中肾盂内压变化对术后并发症的影响。方法采用逆行置入肾盂5F输尿管导管连接测压系统，平均灌注流量300ml／min，平均灌注压191mmHg（1mmHg=0．133kPa），监测76例不同口径通道下MPCNL术中肾盂内压变化，每秒钟采集一次数据，数据实时导入计算机并作统计学分析。结果14、16、18F单通道以及16F双通道下MPCNL术中平均肾盂内压分别为24．85、16．23、11．68及5．83mmHg，肾盂压力〉30mmHg平均累积时间分别为283、96、44、10S，14F单通道MPCNL术中平均肾盂内压均高于16、18F单通道（P〈0．05）及16F双通道（P〈0．001）。结论不同口径通道下MPCNL术中肾盂内压均较低，小于引起肾实质返流的压力极限（30mmHg）。引起灌注液流出受阻因素均可引起肾盂内压明显增高。手术时间过长，肾盂内高压状态累积致使返流达到一定限度可能会引起菌血症。

Objective By monitoring the renal pelvic pressure during MPCNL via different size percutaneous tracts,inspected its influence to postoperative complications. Methods Using a 5 F ureteric catheter positioned in the renal pelvis,with the perfusion flow 300 ml/min and perfusion pressure 191 mm Hg,the renal pelvic pressure was measured in 76 cases by Mindray PM9000 monitor 1BP channel during the MPCNL within 14 F, 16 F, 18 F and Double l6 F percutaneous tracts. The computer collected the renal pelvic pressure dute every second and all the data were evaluated statistically. Results During the MPCNL with 14 F,16F,18F and Double-16 F percutaneous tract,the average renal pelvic pressure was 24.85 mm Hg, 16.23 mm Hg,ll. 68mmHg and 5.83mmHg respectively, the accumulative total time of renal pelvic pressure〉30 mm Hg was 283 s、96 s、44 s and 10 s respectively. The renal pelvic pressure was much higher of 14 F group than that of other groups. Conclusions Renal pelvic pressure remains lower than a level to back-flow （30mmHg） during MPCNL via 14-18 F percutaneous tract. Any factors which brought a poor drainage would result in a temporal elevated renal pelvic pressure greater than 30 mm Hg. But too long time with high pressure status would had an accumulated effect which means an enough back-flow to bring a bacteremia.