不同体位微创经皮肾镜取石术治疗梗阻性结石术中肾盂内压的比较

发布时间：2018-02-16 07:03

本文关键词： 肾盂内压梗阻性结石微创钬激光经皮肾镜　出处：《南昌大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：通过测量微创经皮肾镜钬激光碎石术治疗梗阻性结石术中分别使用18Fr及20Fr peel-away鞘在三种体位下肾盂内压的变化，对肾盂内压进行比较分析。了解微创经皮肾镜钬激光碎石术治疗梗阻性结石术中肾盂内压的安全性,并比较使用不同体位及不同鞘时肾盂内压的大小，同时比较在不同体位下患者的手术耐受性。方法：选择肾盂或输尿管出口有梗阻的结石患者（输尿管上段结石、肾盂结石、多发性肾结石及铸型肾结石），在MPCNL术中随机使用18Fr或20Frpeel-away鞘并随机采用俯卧位、斜俯卧位及侧卧位对其进行分组，利用压力传感器在术中测量肾盂内压，并利用心电监护仪及计算机对数据进行记录。结果：（1）MPCNL治疗梗阻性结石术中采用18Fr鞘在俯卧位、斜俯卧位及侧卧位下测量各组术中肾盂内压平均值分别为27.53±3.58cmH2O、26.51±3.26cmH2O及21.65±2.97cmH2O。各组术中平均肾盂内压均低于一般所认为的引起肾实质返流极限(40cmH2O)。肾盂内压在俯卧位组最高，而在侧卧位组时最低：俯卧位组与斜俯卧位组之间无统计学差异(P=0.236)，但都显著高于侧卧位组(P=0.000，0.001)，具有统计学意义。（2）MPCNL治疗梗阻性结石术中采用20Fr鞘在俯卧位、斜俯卧位及侧卧位下测量各组术中肾盂内压平均值分别为26.60±3.51cmH2O、25.27±3.25cmH2O及20.99±2.73cmH2O。各组术中平均肾盂内压均低于一般所认为的引起肾实质返流极限(40cmH2O)。肾盂内压在俯卧位组与斜俯卧位组之间无统计学差异(P=0.217)，但都显著高于侧卧位组(P=0.01，，0.04)，侧卧位组与俯卧位组及斜俯卧位组之间有统计学意义。（3）MPCNL术中分别采用俯卧位、斜俯卧位及侧卧位时，18Fr与20Fr鞘术中平均肾盂内压均无统计学意义（P=0.275，P=0.177，P=0.236）。（4）MPCNL术中采用俯卧位、斜俯卧位及侧卧位时，术中患者出现呼吸或心前区不适的手术例数分别为7、1、0。斜俯卧位与俯卧位相比有统计学意义（0.02＜P＜0.05），侧卧位与俯卧位相比具有显著的统计学意义（0.005＜P＜0.01），斜俯卧位与侧卧位相比无统计学意义（0.2＜P＜0.4）。结论：（1）在微创经皮肾镜钬激光碎石术治疗梗阻性结石术中，采用侧卧位可明显降低术中肾盂内压。（2）微创经皮肾镜钬激光碎石术治疗梗阻性结石时，采用俯卧位、斜俯卧位及侧卧位时肾盂内压均低于引起灌注液反流的压力极限值（40cmH2O）。（3）微创经皮肾镜钬激光碎石术术中采用斜俯卧位及侧卧位可改善患者手术耐受性。
[Abstract]:Objective: to measure the changes of intrapelvic pressure in patients with obstructive calculi treated by minimally invasive percutaneous nephrolithotripsy with holmium: YAG laser lithotripsy with 18Fr and 20Fr peel-away sheath in three different positions, respectively. To study the safety of minimally invasive percutaneous nephrolithotripsy in the treatment of obstructive calculi, and to compare the size of intrapyelic pressure in different positions and different sheaths, and to compare the safety of intrapyelic pressure in the treatment of obstructive calculi with holmium laser lithotripsy with minimally invasive percutaneous nephrolithotripsy. At the same time, the operating tolerance of patients in different positions was compared. Methods: patients with renal pelvis or ureteral outlet obstruction (upper ureteral calculi, renal pelvis stones, multiple renal calculi and cast renal calculi) were randomly treated with 18Fr or 20Frpeel-away sheath and prone position during MPCNL. They were divided into oblique prone position and lateral position. The pressure sensor was used to measure intrapelvic pressure during operation and ECG monitor and computer were used to record the data. Results:. MPCNL was used to treat obstructive calculi in prone position with 18Fr sheath. The mean intrapelvic pressure was 27.53 卤3.58 cmH2O 26.51 卤3.26 cmH2O and 21.65 卤2.97 cmH2O in oblique prone position and lateral position respectively. The intrapelvic pressure in each group was lower than 40 cm H _ 2O, which caused the limit of renal parenchymal reflux. The intrapelvic pressure was the highest in the prone position group. But in the lateral position group, there was no statistical difference between the prone position group and the oblique prone position group, but they were significantly higher than that in the lateral position group. MPCNL was used to treat obstructive calculi with 20Fr sheath in prone position. The mean intrapelvic pressure in each group was 26.60 卤3.51 cmH2O 25.27 卤3.25 cmH2O and 20.99 卤2.73 cmH2O respectively. The intraoperative mean intrapelvic pressure in each group was lower than the 40 cm H _ 2O limit for renal parenchymal reflux. The intrapelvic pressure in prone position group and oblique prone position group was lower than that in each group. There was no statistical difference between the two groups (P < 0. 217), but they were significantly higher than those in the lateral position group (P < 0. 01). There was statistical significance between the lateral position group, the prone position group and the oblique prone position group. There was no significant difference in the mean intrapelvic pressure between 18Fr and 20Fr during MPCNL, oblique prone position and lateral position. In MPCNL, prone position, oblique prone position and lateral position were used. There were 0. 02 < 0. 02 < P < 0. 05 in oblique prone position and 0. 02 < P < 0. 05 in prone position, 0. 005 < P < 0. 01 in lateral position and 0. 005 < P < 0. 01 in prone position, and 0. 2 < P < 0. 40 in oblique prone position. Conclusion:. During minimally invasive percutaneous nephrolithotripsy with holmium: YAG laser lithotripsy, lateral recumbent position can significantly reduce intrapelvic pressure. (2) during minimally invasive percutaneous nephrolithotripsy with holmium: YAG laser lithotripsy, the pressure of renal pelvis in prone position, oblique prone position and lateral position was lower than the pressure limit of 40 cm H 2O. Minimally invasive percutaneous nephrolithotripsy with holmium: YAG laser lithotripsy in oblique prone position and lateral position can improve the patient's tolerance.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.2

【引证文献】