输尿管软镜术中间接控制肾盂压力的实验研究

发布时间：2018-09-03 14:10

【摘要】：目的：探索家猪输尿管软镜操作手术中肾盂内压40cmH2O时对应的灌注压力。方法：家猪20只，处死后立即显露泌尿系统，40个肾脏随机分成4组。前3组自膀胱内输尿管口先插入F14/12输尿管扩张鞘（留置位置分别为输尿管下段、中段），然后分别插入F7、F8、F9输尿管软镜到达肾盂；第4组不插入输尿管扩张鞘，直接插入F8输尿管软镜达肾盂。40个肾脏均用18G肾穿刺针行肾穿刺达肾盂，接Philips测压装置，，测量肾盂内压。3L袋装生理盐水悬挂不同高度进行灌注，灌注管在肾脏水平通过“三通”接Philips测压装置。记录不同情况下肾盂内压10、20、30、40、50cmH2O时对应的灌注压力。结果：肾盂内压10cmH2O，且使用F14/12输尿管扩张鞘，并留置于输尿管中段时，F7、F8、F9输尿管软镜所对应的灌注压力分别是29.70±0.949、27.50±2.068和24.10±1.792cmH2O；肾盂内压10cmH2O，F8输尿管软镜不使用F14/12输尿管扩张鞘时，所对应的的灌注压力是10.10±1.853cmH2O。肾盂内压20cmH2O，且使用F14/12输尿管扩张鞘，并留置于输尿管中段时，F7、F8、F9输尿管软镜所对应的灌注压力分别是41.70±1.160、39.70±2.003和36.202±.004cmH2O；肾盂内压20cmH2O，F8输尿管软镜不使用F14/12输尿管扩张鞘时，所对应的的灌注压力是22.10±1.853cmH2O。肾盂内压30cmH2O，且使用F14/12输尿管扩张鞘，并留置于输尿管中段时，F7、F8、F9输尿管软镜所对应的灌注压力分别是53.80±1.229、51.90±1.663和48.30±1.947cmH2O；肾盂内压30cmH2O，F8输尿管软镜不使用F14/12输尿管扩张鞘时，所对应的的灌注压力是34.10±1.853cmH2O。肾盂内压40cmH2O，且使用F14/12输尿管扩张鞘，并留置于输尿管中段时，F7、F8、F9输尿管软镜所对应的灌注压力分别是66.10±1.197、64.20±1.398和60.60±2.066cmH2O；肾盂内压40cmH2O，F8输尿管软镜不使用F14/12输尿管扩张鞘时，所对应的的灌注压力是46.40±1.776cmH2O。肾盂内压50cmH2O，且使用F14/12输尿管扩张鞘，并留置于输尿管中段时，F7、F8、F9输尿管软镜所对应的灌注压力分别是77.80±1.317、76.30±1.703和72.30±2.406cmH2O；肾盂内压50cmH2O，F8输尿管软镜不使用F14/12输尿管扩张鞘时，所对应的的灌注压力是58.30±1.947cmH2O。结论：随着灌注压力的升高，肾盂内压逐渐升高；维持肾盂内压40cmH2O时，灌注压力与输尿管软镜外径、输尿管扩张鞘及其留置位置有关系；F7输尿管软镜结合留置于输尿管中段的F14/12输尿管扩张鞘，最能保持出水通道畅通，维持肾盂内压40cmH2O时，所需灌注压力可达到66.10±1.197，最有利于手术的进行，保持手术视野清晰。
[Abstract]:Objective: To explore the corresponding perfusion pressure of 40 cm H2O in pigs undergoing flexible ureteroscopic operation. Methods: 20 pigs were sacrificed and exposed immediately to the urinary system. 40 kidneys were randomly divided into 4 groups. No F7, F8, F9 ureteroscope was inserted into the renal pelvis; group 4 did not insert the dilated sheath of the ureter, but directly inserted the F8 ureteroscope into the renal pelvis. Results: The perfusion pressures of F7, F8, F9 ureteroscopes were 29.70 (+0.949), 27.50 (+2.068) and 24.10 (+1.068) respectively when the intrapelvic pressure was 10 cm H2O and the F14/12 ureter sheath was dilated and placed in the middle ureter. The corresponding perfusion pressure was 10.10 [1.853] cmH2O. The intrapelvic pressure was 20 cmH2O, and the perfusion pressure was 41.70 [1.160] and 39.70 [2.003] respectively when the intrapelvic pressure was 10.10 [1.853] cmH2O] and the intrapelvic pressure was 10.10 [1.853] cmH2O] respectively. When the intrapelvic pressure was 20 cm H2O and the F8 ureteroscope did not use the F14/12 ureteral dilatation sheath, the corresponding perfusion pressure was 22.10+1.853 cm H2O. The intrapelvic pressure was 30 cm H2O, and when the F14/12 ureteral dilatation sheath was used and kept in the middle segment of the ureter, the corresponding perfusion pressure of the F7, F8 and F9 ureteroscopes was 53.80+1.229, respectively. The corresponding perfusion pressure was 34.10 (+ 1.853) cm H2O. The intrapelvic pressure was 40 cm H2O, and the perfusion pressure was 6 for F7, F8 and F9 ureteroscopes when they were placed in the middle segment of the ureter. When the intrapelvic pressure was 40 cm H2O and the F8 ureteroscope did not use the F14/12 ureteral dilatation sheath, the corresponding perfusion pressure was 46.40+1.776 cm H2O. The perfusion pressures were 77.80 [1.317], 76.30 [1.703] and 72.30 [2.406] cmH2O, respectively. The perfusion pressures were 58.30 [1.947] cmH2O when the intrapelvic pressure was 50 cm H2O and the F8 ureteroscope did not use the F14/12 ureteral dilatation sheath. F7 ureteroscope combined with F14/12 ureteral dilatation sheath in the middle ureter can keep the effluent passage unobstructed and maintain the intrapelvic pressure of 40 cm H2O, the required perfusion pressure can reach 66.10 (+ 1.197), which is most conducive to the operation and keep the surgical field clear.
【学位授予单位】：宁波大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.4

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