经皮肾镜碎石取石术中不同肾盂内压力与围术期并发症相关性研究  

Correlation between different renal pellis pressures and perioperative complications during percutaneous nephrolithotomy

作　　者：曹智 朱希望 王尉 张辉 杨成林 张小明 zhi Cao;Xiwang Zhu;Wei Wang;Hui Zhang;Chenglin Yang;Xiaoming Zhang(Department of Urology,General Hospital of the Southern Theater Command of the People's Liberation Army of China,Guangzhou 510010,China)

机构地区：[1]中国人民解放军南部战区总医院泌尿外科,广州510010

出　　处：《中华腔镜泌尿外科杂志（电子版）》2023年第6期616-620,626,共6页Chinese Journal of Endourology(Electronic Edition)

基　　金：军队医学科技青年培育计划项目(21QNPY125);广州市科技计划项目基础与应用基础研究项目(202002030030);广东省基础与应用基础研究基金项目(2020A1515010044)。

摘　　要：目的探讨经皮肾镜碎石取石术(PCNL)中不同肾盂内压力状况对患者围术期并发症影响。方法回顾性分析2017年8月至2019年12月在中国人民解放军南部战区总医院接受PCNL治疗的189例复杂性肾结石患者的临床资料。根据术中肾盂内测压情况分组为瞬时高压组、短暂高压组与持续高压组。分析各组患者手术时间、冲水量、灌注液外渗、一期结石清除率等指标,对比分析患者术后发热、脓毒血症性休克发生率,术后Hb、HCT、Na+下降程度,术后血WBC、PCT升高程度等。结果灌注液外渗情况瞬时高压组(8%)<短暂高压组(18.4%)<持续高压组(22.6%)(P<0.05)。术后发热、脓毒血症性休克发生率,术后HCT、Na+下降程度,术后血WBC、PCT升高程度,三组之间对比差异有统计学:瞬时高压组[20.69%,2.30%,(0.09±0.01),(9.3±0.6),(2.6±0.2),(2.1±0.4)]<短暂高压组[28.57%,6.12%,(0.13±0.01),(12.3±0.9),(3.3±0.4),(5.2±1.7)]<持续高压组[45.28%,11.32%,(0.16±0.01),(13.8±0.9),(5.1±0.5),(9.8±1.8)](P<0.05)。结论PCNL术中长时间维持肾盂内高压状态会明显提升患者围术期并发症发生率。ObjectiveTo investigate the effect of different intrarenal pressures on perioperative complications in patients undergoing percutaneous nephrolithotomy (PCNL).MethodsThe clinical data of 189 cases of complex kidney stones who underwent PCNL in General Hospital of the Southern Theater Command of the People's Liberation Army of China from August 2017 to December 2019 were retrospectively analyzed. According to the intraoperative pressure measurement in the renal pelvis, the patients were divided into instant high pressure group, transient high pressure group and sustained high pressure group. The operation time, flushing volume, extravasation of perfusate, primary stone clearance rate and other indicators of patients in each group were analyzed;postoperative conditions of patients were compared and analyzed: postoperative fever, incidence of septic shock, postoperative Hb, HCT, Na+ decrease degree, postoperative blood WBC, PCT elevation and so on.ResultsThere were significant differences in the extravasation of perfusate among the three groups, among which the instant high pressure group (8%) < transient high pressure group (18.4%) < sustained high pressure group (22.6%) (P< 0.05). The incidence of postoperative fever and septic shock, the degree of postoperative, HCT, Na+ decline, and the postoperative blood WBC and PCT elevations were statistically different among the three groups: instant high pressure group [20.69%, 2.30%, (0.09±0.01), (9.3±0.6), (2.6±0.2), (2.1±0.4)]< transient high pressure group [28.57%, 6.12%, (0.13±0.01), (12.3±0.9), (3.3±0.4), (5.2±1.7)]< sustained high pressure group [45.28%, 11.32%, (0.16±0.01), (13.8±0.9), (5.1±0.5), (9.8±1.8)] (P<0.05).ConclusionLong-term maintenance of high pressure in the renal pelvis during percutaneous nephrolithotomy can significantly increase the incidence of perioperative complications.

关 键 词：肾结石 肾盂压力 经皮肾镜 并发症 

分 类 号：R699.2[医药卫生—泌尿科学]