摘要
目的探讨采用新型李逊微创肾镜行微创经皮肾穿刺取石术（MPCNL）通道大小及数目与肾盂内压变化的关系。方法对203例肾结石患者行MPCNL，采用新型李逊微创肾镜（8．5／12F），高压脉冲灌注泵生理盐水冲洗，气压弹道碎石，通过逆行置入肾盂的6F输尿管导管连接测压系统，监测167例16F-24F单通道及36例多通道PCNL术中肾盂内压的变化，作统计学分析。结果共有单通道PCNL156例及多通道PCNL33例进入数据统计分析，16F、18F、20F、22F以及24F通道下PCNL术中平均肾盂内压分别为（38．96±5．39）cmH2O、（32．11±7．35）cmH2O、（29．42±4．53）cmH2O、（22．67±5．22）cmH2O及（17．25±5．12）cmH2O（1cmH2O=0．098kPa），双通道、三通道以及四通道下PCNL术中平均肾盂内压分别为（17．62±4．72）、（16．01±5．54）及（13．93±3．48）cmH2O。16F通道PCNL术中平均肾盂内压高于20F、22F、24F通道（P〈0．05），20F单通道PCNL术中肾盂内压高于多通道（P〈0．01）。结论16F～24F微通道微创肾镜PCNL术中平均肾盂内压均低于引起肾实质反流的压力安全值（40cmH2O），处理铸型结石采用多通道PCNL可降低肾盂内压。18—20F可作为微创肾镜PCNL的首选通道。
Objectives To explore the relationship between the variation of diameter or number of tracts and intrarenal pelvic pressure （IPP） during minimally invasive pereutaneons nephrolithotomy （MPCNL） with newly designed Li - xun mini nephroscope. Methods 203 patients underwent MPCNL using 8.5/12F mini nephroscope, normal saline rinsed by high - pressure pulse perfusion pump, and pneumatic lithotriptor were enrolled in this study （ single tract access, n = 167, multiple tract access, n = 36 ）. An open - end 6Fr ureteral catheter was inserted into the target ureter. The data of intrarenal pelvic pressures were measured with urodynamic work stations. Results 189 cases were enrolled in this study （single tract access, n = 156, multiple tract access, n = 33 ） ,The average IPP of different nephrostomy tube diameter of MPCNL such as 16F, 18F, 20F, 22F, 24F were （38.96 ± 5.39） cmH2O, （32.11 ±7.35）cmH2O, （29.42 ±4.53）cmH2O, （22.67 ±5.22） cmH2O and （17.25 ±5.12）emH2O （lcmH2O =0. 098 kPa）. And the average IPP of different number of access tracts of MPCNL such as dual -chan- nels, three - channels, and four - channels were （ 17.62 ± 4.72 ） cmH2O, （ 16.01 ± 5.54 ） cmH2O and （ 13.93 ± 3.48） cmH2O, respectively. IPP of nephrostomy tube diameter （16F） was significant higher than tube diameter （20F,22F,24F, P 〈 0.05） ,and can easily become higher than 40 emil20. IPP of single access tract of 20F was significant higher than multiple tract access （ P 〈 0.01 ）. Conclusions IPP of MPCNL by different diameters and numbers of tracts were lower than the safety level （40 cmH2O）. We carried multiple access tracts in treating staghorn calculi could decrease the IPP, and the tract of 18 -20F could be used as the first choice for MPCNL using 8.5/12F nephroscope.
出处
《国际泌尿系统杂志》
2012年第4期462-465,共4页
International Journal of Urology and Nephrology
基金
广东省清远市科技计划项目
关键词
肾结石
外科手术
内窥镜
碎石术
Kidney Calculi
Surgical Procedures, Endoscopic
Lithotripsy
