微创经皮肾镜取石术中肾盂压力对肾功能的影响

目的探讨经皮肾镜取石术中肾盂压力变化对肾功能的影响。方法将我院收治肾结石患者行微创经皮肾镜取石术治疗的78例,术前测定患者血清电解质、血肌酐(SCr)和血尿素氮(BUN),术中通过逆行置入的输尿管导管连接尿动力学仪监测患者肾盂压力,将术中肾盂压力≥40cmH2O,且累计时间≥10min的患者作为高压组;其余患者作为低压组,手术后1、3、5d再次测定患者的血清电解质、SCr和BUN水平。结果手术前两组患者血清电解质(Na+、K+、Cl-)、SCr和BUN水平差异无统计学意义(P>0.05),手术后1、3、5d两组患者血Na+、Cl-、SCr、BUN均较术前有所升高,血K+较术前有所降低(P<0.05);高压组上述指标变化较低压组更大,两组数据间差异有统计学意义(P<0.05)。结论微创经皮肾镜取石术中肾盂压力持续过高会影响患者早期的肾功能,控制术中肾盂压力对患者术后恢复有积极意义。

The Impact of Intrapelvic Renal Pressure on Renal Function in Minimal Damage Percutaneous Nephrolithotomy

Objective To investigate the impact of intrapelvic renal pressure on renal function in minimal damage percutaneous nephrolithotomy.Methods 78 patients with kidney stones taken minimal damage percutaneous nephrolithotomy were recruited.Serum electrolytes,creatinine(SCr) and blood urea nitrogen(BUN),intraoperative retrograde placement of ureteral catheter connection urodynamics were monitored before operation.Patients with the renal pelvic pressure ≥ 40cmH2O cumulative time ≥ 10min were taken as hypertension group and the rest patients were taken as low-pressure group.The patient’s serum electrolytes,blood creatinine(SCr) and blood urea nitrogen(BUN) levels were measured at 1st,3rd,and 5th day after surgery.Results serum electrolytes of(Na+,K+,Cl-),creatinine(SCr) and blood urea nitrogen(BUN) level was no significant difference(P>0.05) between two groups before surgery.Na+,Cl-,SCr and BUN at 1st,3rd,and 5th day after surgery significantly increased compared with those before surgery and postoperative blood K+ significantly decreased compared with the preoperative one(P<0.05).Conclusion Lithotomy persistent high pressure in the pelvis with minimal damage percutaneous nephrolithotomy will increase the occurrence of postoperative complications at early stage.Control of renal pelvic pressure has a positive meaning.on postoperative recovery.