摘要
目的探讨超微经皮肾镜术中肾盂压力变化对肾功能及术后感染并发症的影响。方法选取2018年5月至2019年5月我院收治的80例上尿路结石患者,按随机数字表法分为两组,分别为16F微通道组(40例)和12F超微通道组(40例),两组术中将逆行置入患侧的输尿管导尿末端连接尿动力学检查仪,手术灌注压力保持不变,每秒钟采集1次数据,做统计学分析。测定患者术前及术后1 d的血肌酐(SCr)和尿素氮(BUN)、统计术后发热(体温>38℃)、血常规白细胞计数升高(白细胞数计数>10×10^9/L)、降钙素原升高(PCT>0.5 ng/mL)及其他常见并发症。结果超微通道组碎石中平均肾盂内压力为(24.6±4.2)mmHg;微通道组碎石中平均肾盂内压力为(32.3±6.1)mmHg,微通道组肾盂内压高于超微通道组(P<0.05);超微通道组结石清除率为95.0%(38/40),微通道组结石清除率为80.0%(32/40),微通道组结石清除率低于超微通道组(P<0.05);术后测定的两组患者术后1 d的血肌酐和尿素氮均高于术前,微通道相比于超微通道组指标差异更大,但两组数据的差异无统计学意义(P>0.05)。术后感染并发症发生率:微通道组术后发热、白细胞异常升高及降钙素原升高发生率均高于超微通道,差异有统计学意义(P<0.05)。结论超微肾镜的经皮肾镜术中肾盂压力低于微通道组,且肾盂内压低于引起肾盂内返流的极限压力值,在减少术后并发症的同时提高了结石清除效率,并且更小的通道使手术创伤进一步减小,对肾功能的影响更小。
Objective To investigate the effect of pressure change of renal pelvis on renal function and postoperative infection complications during ultrafine percutaneous nephroscopy.Methods 80 cases of patients with urinary stones in our hospital from May 2018 to May 2019 were selected and they were divided into two groups according to random number table method:the 16F micro channel group(40 cases)and the 12F superfine channel group(40 cases).Retrograde insertion of the end of ureteral catheterization into the affected side was performed during surgery in the two groups,operative perfusion pressure remained constant,data was collected once per second,and then statistical analysis was made.Serum creatinine(SCr)and blood urea nitrogen(BUN)were measured before and 1 day after surgery,post-operative fever(body temperature>38℃),elevated white blood cell count(white blood cell count>10×10^9/L),elevated procalcitonin(PCT>0.5)and other common complications were counted.Results The mean intrapelvic pressure in the ultramicrochannel group and the microchannel group was(24.6±4.2)mmHg and(32.3±6.1)mmHg respectively,and the intrapelvic pressure in the microchannel group was higher than that in the ultramicrochannel group(P<0.05).The calculi clearance rate of the ultramicrochannel group was 95.0%(38/40),while that of the microchannel group was 80.0%(32/40).The calculi clearance rate of the microchannel group was lower than that of the ultramicrochannel group(P<0.05).The serum creatinine and urea nitrogen of the two groups measured 1 day after the operation were both higher than those before the operation,and the difference of microchannel index was greater than that of the ultramicrochannel group,but the difference of data between the two groups was not statistically significant(P>0.05).Incidence of postoperative infection complications:the incidence of postoperative fever,abnormal increase of white blood cells and increased incidence of procalcitonin in the microchannel group was higher than that in the ultramicrochannel group,w
作者
章梦石
张大田
Zhang Mengshi;Zhang Datian(Postgraduate Training Base of Dandong Central Hospital of Jinzhou Medical University,Dandong 118000 China;Urology Department,the First Affiliated Hospital of Jinzhou Medical University,Jinzhou 121000 China)
出处
《锦州医科大学学报》
CAS
2020年第2期28-31,共4页
Journal of Jinzhou Medical University
基金
辽宁省教育厅基金资助项目,项目编号:320.2740。
关键词
超微经皮肾镜取石术
肾盂内压
肾功能
术后感染并发症
ultramicro percutaneous nephrolithotomy
renal pelvis pressure
renal function
postoperative infection complications
