低压重力滴注法与灌注泵灌注法在经皮肾镜取石术中肾盂输尿管内压及感染相关指标的对比

季健; 普超; 朱元全; 冯伟

低压重力滴注法与灌注泵灌注法在经皮肾镜取石术中肾盂输尿管内压及感染相关指标的对比

1. 云南省第三人民医院泌尿外科
2. 云南省老年病医院内三科

基金项目:

基金：云南省教育厅科学研究基金资助项目 (2016ZDX050);

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出版历程
- 收稿日期: 2017-08-22

A Comparison of Intrarenal Pelvic Pressure or Endoureteral Pressure and Infection Index between Perfusion Pump and Low Pressure of Gravity Drip during Percutaneous Nephrolithotomy (PCNL)

Funds:

基金：云南省教育厅科学研究基金资助项目 (2016ZDX050);

摘要

摘要: 目的探讨经皮肾镜取石术 (pereutaneous nephrolithotomy, PCNL) 中低压重力滴注法与灌注泵灌注法对患者肾盂输尿管内压及感染相关指标的影响.方法对2015年4月至2017年6月收治的107例肾及输尿管结石患者行PCNL治疗, 以随机数字表法随机分为2组, 2组患者的性别、年龄、术前泌尿系感染情况、肾积水程度、结石直径、结石位置等等比较差异均无统计学意义 (P>0.05) , 分别为采用低压重力滴注法组61例和采用灌注泵灌注法46例.逆行置入肾盂内的F5输尿管导管连接测压系统连接监护仪测压通道, 监测2组PCNL术中肾盂输尿管内平均压力及最高压力.比较2组肾盂输尿管内平均压力及最高压力、结石碎石取石时间、血红蛋白下降值、术后体温、降钙素原及白细胞异常值等指标.结果低压重力滴注法组和灌注泵灌注法组在碎石期间肾盂及输尿管内平均压力 (22.7±4.6) mm Hg (1 mm Hg=0.133 k Pa) 和 (29.8±5.3) mm Hg及最高压力分别为 (28.8±6.56) mm Hg和 (50±9.25) mm Hg, 组间比较差异有统计学意义 (P<0.05) .低压重力滴注法组和灌注泵灌注法组术后体温[4.9% (3/61) vs 17.3% (8/46) ]、降钙素原值[3.2% (2/61) vs 15.2% (7/46) ]、白细胞值[9.8% (6/61) VS.28.26% (13/46) ]比较差异均有统计学意义 (P<0.05) ;血红蛋白下降值[ (8.3±3.7) g/L vs (7.2±3.3) g/L]结石清除时间[ (42.4±14.5) min vs (43.6±13.5) min]比较差异均无统计学意义 (P>0.05) .结论与灌注泵灌注法比较, 低压重力滴注法术中肾盂输尿管内压明显低于发生反流的极限值, 术后感染指标低, 发热率低;手术时间, 碎石取石效果方面无明显劣势.
- 经皮肾镜碎石术 /
- 肾盂内压 /
- 输尿管内压 /
- 感染
Abstract: Objective To compare intrarenal pelvic pressure or endoureteral pressure and infection index between perfusion pump and low pressure of gravity drip during percutaneous nephrolithotomy (PCNL) .Methods From 2015 April to 2017 June, 107 patients with ureteral or renal calculus were randomly divided into two groups, among whom 46 cases underwent perfusion pump PCNL and 61 cases underwent low pressure gravity drip PCNL. No statistical significance of preoperative variables was found between the two groups such as age, gender, preoperative status of infection, status of hydrpnephrosis, size and location of stone (P >0.05) .A 5 Fr ureteral catheter was positioned into the renal pelvic or ureter, and the intrarenal pelvic or endoureteral pressure was measured by anesthesia monitor during PCNL for all patients.We recorded and compared removing calculus time, postoperative hemoglobin changing, fever rate, procalcitonin abnormal rate, white blood cell counts and calculi clearance rate.Results The average pelvic or endoureteral pressures in the group undergoing perfusion pump and the one undergoing low pressure gravity drip were (22.7 ±4.6) mm Hg VS (29.8 ±5.3) mm Hg and the maximum pressure were (28.8 ±6.56) mm Hg VS (50 ±9.25) mm Hg.The statistics was significantly different (P <0.05) .Compared with perfusion pump group, the group undergoing low pressure gravity drip had significant differences in fever rate [4.9% (3/61) VS.17.3% (8/46) ], procalcitonin abnormal rate [3.2% (2/61) VS.15.2% (7/46) ] and white blood cell counts abnormal rate [9.8% (6/61) VS.28.26% (13/46) ] (P<0.05) .However, no significant difference was seen in postoperative hemoglobin changing[ (8.3±3.7) g/L VS. (7.2±3.3) g/L] (P>0.05) and the time of removing calculus [ (42.4 ±14.5) min VS (43.6 ±13.5) min] (P >0.05) .Conclusions Compared with perfusion pump, low pressure gravity drip PCNL maintains lower renal pelvic or endoureteral pressure, which is less than reflux limit during calculi fragmentation. It might be contributed to reduce the postoperative fever rate, white blood cell counts abnormal rate and procalcitonin abnormal rate. Hemoglobin changing and the time of removing calculus show no obvious disadvantage.
- Pereutaneous nephrolithotomy /
- Intrarenal pelvic pressure /
- Endoureteral pressure /
- Infection

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参考文献(13)

[1]	[1]YANBO WANG, YAN WANG, YUCHUAN HOU, et al.Standard-Tract combined with mini-tract in percutaneous nephrolithotomyforrenalstaghorncalculi[J].Urologia internationalis, 2014, 92 (4) :422-426.
[2]吴孟超, 吴在德主编.黄家驷外科学[M].第7版.北京:人民卫生出版社, 2008:1432-1480.
[3]	[3]AGARWAL M, AGRAWAL M S, JAISWAL A, et al.Safety and efficacy of ultrasonography as an adjunct to fluoroscopy for renal access in percutaneous nephrolithotomy (PCNL) [J].BJU International, 2011, 108 (8) :1346-1349.
[4]岐宏政, 沈鹏飞, 刘勇, 等.肾镜取石术与开放手术治疗肾结石的系统评价[J].中华腔镜泌尿外科杂志 (电子版) , 2009, 3 (5) :382-388.
[5]	[5]KREYDINEI, EISNERBH.Riskfactorsforsepsisafterpercutaneous renal stone surgery[J].Nat Rev Urol, 2013, 10 (10) :598-605.
[6]	[6]ZHONG W, ZENG G, WU K, et al.Does a smaller tract in pereutaneousnephrolithotomycontribute to high renal pelvic pressure and postoperative fever[J].Endourol, 2008, 22 (9) :2147-2151.
[7]钟文, 曾国华, 杨后猛, 等.微创经皮肾镜取石术中肾盂内压变化对术后发热的影响[J].中华泌尿外科杂志, 2008, 29:668-671.
[8]	[8]NGUYEN H T, KOGAN B A.Renal hemodynamic changes after complete papalunilateral ureteral obstruction fetal lamb[J].J Urol, 1998, 160:1063-1069.
[9]郭宏骞, 史红雷, 李笑弓, 等.微创经皮肾输尿管镜碎石术中肾盂内压与术后康复的关系[J].中华外科杂志, 2008, 46 (1) :52-54.
[10]曾国华, 钟文, 李逊, 等.微创经皮肾穿刺取石术中肾盂内压变化的临床研究[J].中华泌尿外科杂志, 2007, 28 (2) :101-103.
[11]	[11]TROXEL S A, LOW R K.Renal intrapelvic pressure during percutaneous nephrolithotomy and its correlation with the development of postoperative fever.[J].Journal of Urology, 2002, 168 (1) :1348-1351.
[12]杨嗣星, 郑府, 柯芹, 等.软性输尿管镜碎石术中肾盂内压力监测方法及意义[J].中华泌尿外科杂志, 2014, 35 (8) :575-578.
[13]	[13]GUOHUAZ, WENZ, XUNL, etal.Theinfluenceofminimally invasive percutaneous nephrolithotomy on renal pelvic pressureinvivo[J].Surgical Laparoscopy Endoscopy&Percutaneous Techniques, 2007, 17 (4) :307-310.

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