输尿管镜碎石术中肾盂压力的监测

目的 建立输尿管镜术中监测肾盂压力的合理方法 ,获得输尿管镜术中肾盂压力的变化情况.方法 对12例患者输尿管镜碎石术中行肾盂压力监测.11例患者为经皮肾镜取石术后输尿管残留结石;另外1例患者为右输尿管下段结石致右肾感染,一期行经皮肾穿刺造瘘引流术,二期处理右输尿管结石.术中通过肾造瘘管监测肾盂压力的变化.分析不同灌注压力以及输尿管不同部位对肾盂压力的影响.结果 (1)患者术前肾盂压力初始值(IPP0)为(16.9±3.2)cm H2O,术中肾盂压力最高值(IPPmax)为(172.6±32.2)cm H2O明显高于IPP0(P<0.01).(2)相同灌注压力下(100 mm Hg),输尿管下段、中段及上段结石术中IPPmax分别为74.6、93.5 cm H2O及(110.3±2.4)cm H2O.(3)输尿管相同部位结石(上段结石),50、100、200 mm Hg灌注压力时,术中IPPmax分别为(51.0±4.5)、(110.3±2.4)、(193.2±5.9)cm H2O(均P<0.01).结论 输尿管镜碎石术中存在肾盂高压现象,术中肾盂压力变化与灌注泵压力大小、结石部位有关.

Monitoring of intrarenal pressure during ureteroscopic Iithotripsy

Objective To investigate the changes of intrarenal pressure in response to continuous irrigation at different pressures during ureteroseopie lithotripsy. Methods Eleven patients with residual ureteral calculi after pereutaneous nephrolithotomy (PCNL), 8 in the proximal section, 2 in the middle section, 1 in the distal section. And one patient with calculi in the distal ureteral section underwent ureteroscopie lithotripsy. Renal fistula tube was connected with a urine dynamic detector and irrigation was performed continuously through the ureteroscope at different pressures. The baseline intra-pelvic pressure (IPP0) and maximum intra-pelvie pressure (IPPmax) were recorded. Results The average IPP0 was (16.9±3.2) cm H2O. The IPP levels during the ureteroscopic lithotripsy [(172.6±32.2) cm H2O] were all significantly higher than the IPP0(all P<0.01). In response to the irrigation pump pressure of 100 mmHg, the IPPmax during the ureteroscopic lithotripsy in the distal, middle, and proximal ureter were 74.6,93.5, and (110.3±2.4) cm H2O respectively. When the irrigation pump pressure levels were 50, 100, and 200 mm Hg respectively the IPPmax levels during the ureteroscopic lithotripsy in the proximal ureter were (51.0±4.5), (110.3±2.4), and (193.2±5.9) cm H2O respectively (all P<0.01). Conclusion The renal pelvic pressure is signifieanfly increased during ureteroseopic lithotripsy. High renal pelvic pressure is associated with the irrigation pressure and the position of calculi.