一体式软硬质输尿管肾镜与输尿管软镜对术中肾盂内压的影响

Influence of Unibody Flexible and Rigid Ureterorenoscope and Flexible Ureteroscope on Intraoperative Renal Pelvis Pressure

目的探讨一体式软硬质输尿管肾镜与输尿管软镜术中对肾盂内压的影响。方法回顾性分析2015年7月～2016年12月50例PCNL术后残留结石需行二期输尿管软镜碎石术处理的临床资料,根据研究时间的不同分为软硬镜组(25例)和输尿管软镜组(25例)。肾造瘘管通过压力传感器连接Mindray PM 9000型监护仪有创血压通道,监测术中肾盂内压力。结果软硬镜组和输尿管软镜组在碎石过程中肾盂内压力分别为(20. 76±6. 94)、(18. 96±5. 93) mm Hg,差异无统计学意义(t=0. 986,P=0. 329);手术时间分别为(46. 2±10. 8)、(44. 0±9. 5) min,差异无统计学意义(t=0. 763,P=0. 449);2组术后发热[8. 0%(2/25) vs. 4. 0%(1/25)]和白细胞异常升高[12. 0%(3/25) vs. 8. 0%(2/25)]差异均无统计学意义(χ~2=0. 000,P=1. 000;χ~2=0. 000,P=1. 000)。结论一体式软硬质输尿管肾镜降低通过鞘间回水装置不能明显降低肾盂压力,在没有操作鞘的情况下,与传统输尿管软镜鞘产生的术中肾盂压力相似。

Objective To investigate the influence of unibody flexible and rigid ureterorenoscope and flexible ureteroscope on intraoperative renal pelvis pressure.Methods From July 2015 to December 2016,50 patients with residual calculi were treated with secondary ureteroscopic lithotripsy.The patients were divided into either flexible and rigid group(25 cases)or flexible ureteroscope group(routine use of flexible ureteroscope,25 cases)according to different treatment methods.Renal pelvis pressure was monitored by nephrostomy tube which connected the invasive blood pressure channel of Mindray PM 9000 type connection monitor by pressure sensor in the two groups.Results The intraoperative renal pelvis pressures of flexible and rigid group and flexible ureteroscope group were(20.76±6.94)mm Hg and(18.96±5.93)mm Hg,respectively.The difference was not statistically significant(t=0.986,P=0.329).The operation time of flexible and rigid group and flexible ureteroscope group was(46.2±10.8)min and(44.0±9.5)min,and there was no statistical difference(t=0.763,P=0.449).The postoperative fever rates were 8.0%(2/25)and 4.0%(1/25),and the abnormal increase of white blood cells rates were 12.0%(3/25)and 8.0%(2/25),with differences not statistically significant(χ^2=0.000,P=1.000;χ^2=0.000,P=1.000).Conclusion Like flexible ureteroscope,unibody flexible and rigid ureterorenoscope can reduce the pressure of the renal pelvis and the postoperative infection to a certain extent through the sheath return device.