重视上尿路结石手术中肾盂高压与液体反流的管理

Pay much attention to control and manage the high pressure of renal plevic and the backflow ofirrigation during the operation of urolithiasis of upper tract urinary

内镜手术已成为泌尿外科治疗上尿路结石最常用的方法，但其围手术期并发症，特别是以尿脓毒血症为代表的感染性并发症严重威胁患者生命。尿脓毒血症的发生与手术操作过程中灌注液体引发的肾盂高压及液体反流密切相关。通过控制手术过程中的液体灌注、监控肾盂内压和灌注液体的反流等环节，可以有效地控制术中液体反流，从而减少感染性毒素及病原体的播散，降低感染性并发症发生率。本文从尿路梗阻的病理生理学机制出发，对肾盂高压所引发的液体反流及其导致的病理生理学改变、术中压力的控制及肾盂高压时尿脓毒血症的防控进行综述，重点阐述已知的肾盂内压控制范围及关键节点。

Endoscopic surgery has become the most common urological procedure for calculus in upper urinary tract. However, the widespread usage of minimally invasive endoscopic techniques failed to end the occurrence of perioperative complications, especially some fatal complications. The most severe complication of urolithiasis related endoscopic procedure is urosepsis, which is closely related to the backflow of irrigation fluid induced by the high pressure of renal pelvic during the procedure. By controlling the perfusion and drainage during the operation, the liquid backflow can be reduced effectively, thus may reduce the spread of infectious toxins and pathogens, and incidence of infectious complications can be controlled accordingly. In this article, the pathophysiology of urinary obstruction, the backflow which caused by elevated renal pelvic pressure and its subsequent pathophysiological changes, the control of intra-renal gressure and the prevention of urosepsis will be reviewed. The important range of intra-renal pressure and the major steps for pressure control during the operation is emphasized.