经皮肾镜取石术通道大小对肾盂内压及取石效率的影响

Impact of nephrostomy tube diameter on intrapelvic pressure and stone-free rate in percutaneous nephrolithotomy

目的探讨经皮肾镜取石术(PCNL)中皮肾通道大小对肾盂内压变化及取石效率的影响。方法通过逆行置入肾盂的6F输尿管导管连接测压系统,保持平均灌注流量366mL/min,平均灌注压196mmHg(1mmHg=0.133kPa),监测153例不同大小通道下采用8.5/12F微创肾镜行PCNL术中肾盂内压的变化,每秒钟采集一次数据,并测量取出结石体积及取石时间,作统计学分析。结果 16、18、20、22以及24F通道下PCNL术中平均肾盂内压分别为38.97、32.26、29.19、20.62及16.75cmH2O(1cmH2O=0.098kPa),碎石取石速度分别为10.6、16.3、20.6、23.5及21.1mL/h。16F通道PCNL术中平均肾盂内压高于20、22及24F通道(P<0.05),18、20、22及24F通道之间碎石取石速度差异无显著性(P>0.05),均快于16F通道(P<0.05)。结论不同大小通道下PCNL术中平均肾盂内压低于引起肾实质反流的压力安全值(40cmH2O),但16F通道采用8.5/12F微创肾镜行PCNL肾盂内压较高,容易超过40cmH2O。取石效率并不随通道增大而提高。通道大小的选择应考虑结石体积及肾积水情况。18～20F可作为微创肾镜PCNL的首选通道。

[ Objective ] To investigate the effect of different nephrostomy tube diameter on intrapelvic pressure and stone-free rate following pereutaneons nephrolithotomy （PCNL）. [Methods ] 153 patients underwent PCNL using 8.5/12 F nephroseope were enrolled in this study. An open-end 6F ureteral catheter was inserted into the target ureter. Tile average irrigation fluid was about 366 mL/min, average irrigation pressure was 196 mmHg （1 mmHg= 0.133 kPa）. The data collected included intrapelvic pressures, stone volume and the operative time. Intrapelvic pressures were measured with urodynamic work stations every second. [ Results ] The average intrapelvie pressure of dif- ferent nephrostomy tube diameter of 16, 18, 20, 22 and 24 F of PCNL were 38.97, 32.36, 29.19, 20.62 and 16.75 emil20 （1 emH20=0.098 kPa）. And stone-free rate was 10.6, 16.3, 20.6, 23.5 and 21.1 mL/h, respectively. Intrapelvic pressure of nephrostomy tube diameter （16 F） was significant higher than tube diameter （20, 22 and 24F） （P 〈0.05）. The stone-free rate of nephrostomy tube diameter （15-24 F） was faster than tube diameter （16 F） （P 〈0.05）, but there was no remarkable difference among nephrostomy tube diameter （18-24 F） （P 〉0.05）. [Conclusions] Intrapelvic pressures of different nephrostomy tube diameters of PCNL were lower than the safety level （40 cmH20）. The intrapelvic pressure of tube diameters （16 F） can easily become higher than 40 cmH20. The stone-free rate had no relevant with nephrostomey tube diameter. Tube diameter （18-20 F） could be used as the first choice for PCNL using 8.5/12 F nephroscope.