摘要目的 探讨经皮肾镜取石术(PCNL)中通道大小对肾盂内压的影响.方法 对2014年4月至2015年7月收治的83例肾结石患者行PCNL治疗,按照随机数字表法随机分为2组,分别为采用F24通道组40例和采用F16通道组43例.两组均为单侧肾结石,结石直径20 ～ 40 mm.两组患者的年龄、性别、术前泌尿系感染、肾积水、结石直径、结石位置等比较差异均无统计学意义(P＞0.05).通过逆行置入肾盂内的F6输尿管导管连接测压系统,监测两组PCNL术中碎石前、碎石中、碎石后的肾盂内压力,比较两组的结石清除时间、血红蛋白丢失值、术后发热率、降钙素原及白细胞异常升高率、一期结石清除率等指标.结果 F24通道组和F16通道组在碎石前、中、后肾盂内压力分别为(7.5±1.3)、(22.5±4.3)、(14.0 ±2.7)mmHg(1 mmHg=0.133kPa)和(10.3±1.1)、(34.6±4.1)、(23.0±3.6) mmHg,组间比较差异有统计学意义(P＜0.05).F24通道组和F16通道组的结石清除时间[(12.8±3.7) min vs.(23.3 ±3.6)min]、术后发热率[17.5％ (7/40) vs.39.5％ (17/43)]、降钙素原异常升高率[15.0％(6/40) vs.34.9％(15/43)]、白细胞异常升高率[10.0％ (4/40)vs.27.9％(12/43)]比较差异均有统计学意义(P＜0.05),血红蛋白丢失值[(11.8±4.4)g/Lvs.(13.7±4.7) g/L]及一期结石清除率[87.5％ (35/40) vs.81.4％ (35/43)]比较差异均无统计学意义(P＞0.05).结论 与F16通道比较,F24通道PCNL术中的肾盂内压低于发生反流的极限值,术后发热率低,手术时间短,碎石取石效果明显.

abstractsObjective To explore the size of access channel that may influence the intrarenal pelvic pressure during percutaneous nephrolithotomy.Methods From April 2014 to July 2015,83 patiens with unilateral renal calculus,ranged from 20 to 40mam were divided into 2 group randomly.40 cases underwent F24 channel PCNL and 43 cases underwent F16 channel PCNL.There was no statistically significant difference between the groups in preoperative variables,such as age,gender,preoperative status of infection,status of hydrpnephrosis,size and location of stone (P ＞ 0.05).We used a 6Fr ureteral catheter positioned into the renal pelvic,and the intrarenal pelvic pressure was measured by anesthesia monitor IBP channel during PCNL in different stages (entrance into the collecting system,calculi fragmentation,and termination)for all patients.Removing calculus time,postoperative hemoglobin changing,fever rate,procalcitonin abnormal rate,white blood cell counts and calculi clearance rate were recorded and compared.Results The intrarenal pelvic pressure in different stages on F24 channel and F16 channel were (7.5 ± 1.3)、(22.5± 4.3)、(14.0 ± 2.7) mmHg and (10.3 ± 1.1)、(34.6 ± 4.1)、(23.0 ± 3.6) mmHg,respectively.There was statistically significant difference between 2 groups (P ＜ 0.05).Compared with F16 channel,F24 channel had significant differences in removing calculus time [(12.8 ± 3.7) min vs.(23.3 ± 3.6) min],fever rate [17.5％ (7/40) vs.39.5％ (17/43)],procalcitonin abnormal rate [15.0％ (6/40) vs.34.9％(15/43)] and white blood cell counts abnormal rate [10.0％ (4/40) vs.27.9％ (12/43)] (P ＜ 0.05).However,no significant difference in postoperative hemoglobin changing [(11.8 ± 4.4)g/L vs.(13.7 ±4.7)g/L] and calculi clearance rate [87.5％ (35/40) vs.81.4％ (35/43)] (P ＞0.05).Conclusions Compared with F16 channel,the F24 channel PCNL maintains lower renal pelvic pressure,which is less than reflux limit,during calculi fragmentation,It might be contributed to reduce the postoperative fever rate.It can short time for removing calculi and achieve the better effect.