经肾造瘘通道持续肾盂内压力监测在输尿管软镜碎石术中的应用

Application of continuous intrapelvic pressure monitoring through nephrostomy channel in flexible ureteroscopic lithotripsy

目的观察经肾造瘘通道肾盂内压力持续监测在输尿管软镜碎石术治疗输尿管上段结石中的安全性,分析对患者炎症指标的影响,为临床推广该技术提供依据。方法选取2022年10月—2023年12月在蚌埠医科大学第一附属医院行输尿管软镜碎石的输尿管上段结石患者,根据术前是否行经皮肾造瘘术分为观察组和对照组。观察组在手术开始前,经皮肾造瘘管连接测压装置,术中在肾盂内压力监测和控制下手术治疗。观察并记录患者术后体温波动,分析术前及术后1 d血白细胞(white blood cell,WBC)、血小板(platelet,PLT)及C反应蛋白(C-reactive protein,CRP)等炎症指标的变化。术后1个月通过尿路平片(KUB)评价结石残留情况。结果共纳入结石患者50例,观察组20例,对照组30例。2组患者一般资料比较差异无统计学意义(P>0.05)。2组在手术时间、住院时间和术后结石残留等方面比较差异均无统计学意义(P>0.05)。观察组患者术后发热的发生率低于对照组患者,但差异无统计学意义。2组患者术前血WBC、PLT和CRP水平比较差异无统计学意义(P>0.05)。术后WBC和CRP水平均高于术前(P<0.05),但PLT水平差异无统计学意义(P>0.05)。观察组患者术后WBC和CRP表达均低于对照组患者,差异有统计学意义(P<0.05),而PLT水平差异无统计学意义(P>0.05)。结论经肾造瘘通道持续肾盂内压力监测可有效控制输尿管软镜碎石中的肾盂内压力,防止术中和术后感染的发生。该操作简单易行,值得临床推广和应用。

Objective To observe the safety of continuous monitoring of renal pelvis pressure through the nephrostomy channel in the treatment of upper ureteral stones with ureteroscopic lithotripsy,analyze the impact on inflammatory indicators,and provide a basis for clinical promotion of this technology.Methods Patients with upper ureteral stones who underwent ureteroscopic lithotripsy at First Affiliated Hospital of Bengbu Medical University from October 2022 to December 2023 were collected.All patients were divided into an observation group and a control group based on whether they underwent percutaneous nephrostomy before surgery.The observation group was connected to a pressure measuring device through a nephrostomy tube before the surgery,and surgical treatment was performed under pressure monitoring and control in the renal pelvis during the operation.Postoperative temperature fluctuations of patients were observed and recorded,and changes in inflammatory indicators,including white blood cell(WBC),platelet(PLT),and C-reactive protein(CRP)were analyzed on the first day after surgery.The residual stones were evaluated by plain film of kidney-ureter-bladder(KUB)one month after surgery.Results A total of 50 patients with stones were included,with 20 in the observation group and 30 in the control group.There was no statistically significant difference in general information between the two groups of patients(P>0.05).There was no statistically significant difference(P>0.05)in terms of surgical time,hospital stay,or residual stones.The incidence of postoperative fever in the observation group was lower than that in the control group,though there was no significant difference.There was no significant difference in preoperative blood WBC,PLT,or CRP levels between the two groups of patients(P>0.05).The postoperative WBC and CRP levels were higher than preoperative levels(P<0.05),but there was no significant difference in PLT level between preoperative and postoperative levels(P>0.05).The expressions of WBC and CRP in the observation group were significantly lower than those in the control group after surgery(P<0.05),while the PLT level was not significantly different(P>0.05).Conclusion Continuous monitoring of intrapelvic pressure through the nephrostomy channel can effectively control the intrapelvic pressure during ureteroscopic lithotripsy and prevent intraoperative and postoperative infections.This operation is simple and feasible,so is worthy of clinical application.