有、无负压装置微创经皮肾镜取石肾盂内压变化对比研究

Comparative study on the change of renal pelvic pressure in MPCNL with negative/non-negative pressure suction system

目的探讨有、无负压装置微创经皮肾镜取石两者术中肾盂内的压力变化。方法实验组为有负压吸引装置的微创经皮肾镜取石术患者共31例,对照组为传统无负压吸引装置的微创经皮肾镜取石术患者共28例,两组每例患者均采用逆行插入5F输尿管导管进肾盂,输尿管导管连接测压系统,常规建立16F经皮肾通道,实验组应用16F金属经皮肾镜碎石清石鞘代替peel-away鞘,金属鞘另接负压吸引,负压0.01～0.02MPa(1MPa=1000kPa)。对照组应用peel-away鞘,两组均通过经皮微通道置输尿管镜入肾盂肾盏,用钬激光碎石,平均灌注流量412ml/min,监测两组手术过程中肾盂内压变化,每秒钟采集一次数据,数据传入计算机记录并分析。结果两组共59例均顺利完成手术,术中监测实验组肾盂内压为-23mmHg～34mmHg(1mmHg=0.133kPa),平均2.1mmHg,平均肾盂内压超过30mmHg为21秒。对照组肾盂内压力为3mmHg～78mmHg,平均肾盂内压力为11.3mmHg,平均每例手术肾盂内压超过30mmHg为188秒。两组肾盂内压进行对比,差异有统计学意义(P<0.05)。结论有负压吸引装置的微创经皮肾镜取石术中肾盂内压力低,甚至为负压,明显低于无负压吸引装置的微创经皮肾镜取石,有利于减少因肾盂内压高而带来的手术并发症。

Objective To study the change of renal pelvic pressure in MPCNL with negative pressure system Methods 59 patients with renal stones underwent MPCNL. In 31 cases （group A）, a negative pressure system was used. A traditional MPCNL without negative pressure system underwent in 28 patients as control （ group B ）. A 5F ureteral catheter was inserted into renal pelvis and connected to the pressure monitering system. In group A, a 16F metal patented sheath was used to substitute the Peel-away sheath. The metal patented sheath was connected to a negative pressure system with negative pressure 0.01-0.02 MPa. 80W holmium laser lithotripsy was conducted. The average instillation flow rate was 412 ml/min. The renal pelvic pressure was recorded every one second and stored in the computer for analysis. Results MPCNL was successful in all 59 patients . In group A, renal pelvic pressure maintained from -23 mmHg to 34 mmHg （mean 2.1 mmHg） during the procedure. The pressure was over 30 mmHg in 21 seconds only. While in group B, the renal pelvic pressure reached 3 mmHg-78 mmHg （mean 11.3 mmHg）, and the pressure over 30 mmHg lasted for 188 seconds on average. There was significant difference between two groups in renal pelvic pressure change （P〈0.05）. Conclusion MPCNL with negative pressure suction system can maintain a low renal pelvic pressure throughout the operation. Many complications will be obviated because of the high pressure.