输尿管镜碎石术中上尿路尿动力学变化对术后肾功能的影响

THE EFFECT OF THE CHANGE OF UPPER URINARY TRACT URINE DYNAMICS ON THE POSTOPERATIVE RENAL FUNCTION IN THE URETER LITHOTRIPSY

目的探讨输尿管镜碎石术中上尿路尿动力学变化与术后肾功能的关系,建立输尿管镜术中肾盂内压的监测方法。方法对91例输尿管结石患者行输尿管镜治疗,术中用尿动力学分析仪监测患者肾盂内压变化,根据术中肾盂内压是否大于生理压力4.0kPa,时间是否超过10min为界,将患者分为高压组(≥10min)和低压组(<10min)进行比较。研究肾盂内压、高压持续时间等因素与术后肾功能的关系。结果高压组34例,低压组57例,本组患者术后肾功能及肾脏形态较术前有明显差异;肾周积液发生率高压组明显高于低压组,差异具有统计学意义。结论肾盂返流存在于输尿管镜术中并可引起相关肾功能改变;肾功能的改变与术中肾盂高压、高压持续时间等因素相关。

Objective To investigate the relationship between the changes of upper urinary tract urine and the renal function after ureter lithotrips and establish a method to monitor the intrapelvic pressure . Methods Totally 91 cases of ureteral calculi were treated with ureteroscopy ,monitored the pelvic pressure by urodynamic analyzer ,the patients were divided into the high‐pressure group（≥10min） and low‐pres‐sure group （〈10min） according to whether or not intraoperative intrapelvic pressure is greater than the physiological pressure 4 .0 kPa .The rlated index ,researched the relationship between pelvic pressure ,the high pressure duration and postoperative complications were compared .Results There were 34 cases in the high‐pressure group ,and 57cases in the low‐pressure group .Renal function and morphology after operation were different from preoperative ,the perirenal effusion rate in the high‐pressure group was signifiantly higher than that in the low‐group , the difference is statistically significant . Conclusion The renal pelvic reflux is associated with the renal function changes dur‐ing the endoscopy ,and the changes of renal function are related to the renal pelvis pressure and the duration of high pressure .