微创经皮肾镜取石术中肾盂压力对肾功能的影响

目的：探讨微创经皮肾镜取石（MPCNL）术中肾盂内压力变化对肾功能的影响。方法：通过逆行所置输尿管导管连接尿动力学仪监测肾盂内压力,术后即刻及术后每天测定尿蛋白：尿微量白蛋白（尿Alb）及B2微球蛋白（尿β2-M）。结果：肾盂内压力≥3．92kPa的总时间≥5min为高压组,高压组肾盂压力平均为2．59kPa（1．27～14．60kPa）,低压组平均为2．19kPa（1．08～12．25kPa）;术后即刻尿蛋白明显增高,与术前相比差异有统计学意义（P〈0．05）,此后尿蛋白逐渐下降,高压组与低压组同一天所测尿蛋白相比差异有统计学意义（P〈0．05）。结论：MPCNL大部分时间其肾盂压力是相对安全的,MPCNL术后出现了短暂肾功能损害,且肾盂压力越高,肾功能损害越严重。

Impact of Intrapelvic Renal Pressure on Renal Function in MPCNL

Objective：To explore the impact of pelvis pressure on renal function in Mini-percutaneotis nephrolithotomy （MPCNL）. Methods：We monitored the intrapelvic pressure by urodynamic instrument which connected with ureteral catheter, and analyzed the data of the urinary protein excretion which were measured instantly after the operation and in the following days. The urinary protein include microalbuminuria and 132 -microglobulin（l？2-M） . Results： The average intrapelvic renal pressure was 2.59 kPa （1.27-14.60 kPa） in high pressure group, and it was 2.19 kPa （1.08--12.25 kPa） in low pressure group. The definition of high pressure was the time of the pressure more than 3.92 kPa not less than 5 rain. All patients had the change of urinary protein that amount of urinary protein were raised up obviously shortly after the operation while being decreased gradually afterward. The difference of urinary protein was of statistical significance between pre-operation and post-operation（ P 〈 0.05）, So does this difference, between statistics of high pressure group and low pressure group in same day（ P 〈 0.05） . Conclusions：The intrapelvic pressure was safe during most of the time in MPCNL. Kidney failure happens to patient temporary right after the surgery MPCNL. The higher the intrapelvic renal pressure is, the more damaged to the renal function.