Abstract:

Objective To evaluate the method of controlling renal pelvic pressure in single tract minimally invasive percutaneous nephrolithotomy （MPCNL）. Methods Eighty patients with renal stones underwent MPCNL were selected and assigned to two groups. The observation group （40 cases） was treated with real?time intraoperative monitoring of renal pelvic pressure operation ，adjustment of the perfusion fluid filling and flowing，and control of the intra?pelvic pressure，The control group（40 cases） only was recorded the intra?pelvic pressure. The perfusion fluid volume ，average renal intrapelvic pres? sure，intrapelvic pressure ≥30 mmHg cumulative time，operation time and postoperative complications were compared between the two groups. Results For the observation group and the control group，the perfusion fluid volume（L）were 14.5±3.8，26.8±6.5，the average renal intrapelvic pressure （mmHg） were 14.33±3.71，28.4±5.5，the renal intra?pelvic pressure ≥30 mmHg cumulative time（s）were 42.4± 5.7，368.4±20.7，which demonstrated significant differences （P<0.05）. The average operation time （min）were 123±20，119±31，with no significant difference（P>0.05）. The occurrences of postoperative pain，fever，WBS increase in the control group were significantly higher than the test group （P<0.05）. Conclusion         The operation of controlling liquid perfusion volume can produce effective control of renal pelvis pressure operation in the MPCNL，which makes the operation safer.

Key words: MPCNL, monitor, perfusion fluid volume, renal pelvic pressure, renal calculi

摘要：

目的 探讨微创经皮肾穿刺取石术中控制肾盂内压升高的方法 。方法 选择80例行单通道MPCNL的肾结石患者，分为两组，控压组（40例）：术中实时监测肾盂内压力，术者采取调控灌注液体入出量，控制肾盂内压升高；对照组（40例）仅记录肾盂内压。比较两组平均灌注液用量、平均肾盂内压、肾盂内压≥30mmHg累计时间、手术时间及术后并发症。结果 两组术中平均灌注液用量（L）为14.33±3.72、28.40±5.52；平均肾盂内压（mmHg）为14.5±3.8、26.8±6.5；肾盂压力>30 mmHg平均累积时间（s）分别为42.4±5.7、118.4±20.8，存在显著差异（P<0.05）；手术时间（min）为110±20、103±31，无显著性（P>0.05），对照组术后疼痛、发热、白细胞增高患者人数发生显著高于控压组（P<0.05）。结论 术中调控灌注液体出入量，能够降低MPCNL术中肾盂内压，提高手术安全性。

关键词: 微创经皮肾穿刺术, 肾盂内压, 灌注液用量 , 肾结石, 监测仪