摘要目的 建立输尿管镜术中监测肾盂压力的合理方法 ,获得输尿管镜术中肾盂压力的变化情况.方法 对12例患者输尿管镜碎石术中行肾盂压力监测.11例患者为经皮肾镜取石术后输尿管残留结石;另外1例患者为右输尿管下段结石致右肾感染,一期行经皮肾穿刺造瘘引流术,二期处理右输尿管结石.术中通过肾造瘘管监测肾盂压力的变化.分析不同灌注压力以及输尿管不同部位对肾盂压力的影响.结果 (1)患者术前肾盂压力初始值(IPP0)为(16.9±3.2)cm H2O,术中肾盂压力最高值(IPPmax)为(172.6±32.2)cm H2O明显高于IPP0(P<0.01).(2)相同灌注压力下(100 mm Hg),输尿管下段、中段及上段结石术中IPPmax分别为74.6、93.5 cm H2O及(110.3±2.4)cm H2O.(3)输尿管相同部位结石(上段结石),50、100、200 mm Hg灌注压力时,术中IPPmax分别为(51.0±4.5)、(110.3±2.4)、(193.2±5.9)cm H2O(均P<0.01).结论 输尿管镜碎石术中存在肾盂高压现象,术中肾盂压力变化与灌注泵压力大小、结石部位有关.

abstractsObjective To investigate the changes of intrarenal pressure in response to continuous irrigation at different pressures during ureteroseopie lithotripsy. Methods Eleven patients with residual ureteral calculi after pereutaneous nephrolithotomy (PCNL), 8 in the proximal section, 2 in the middle section, 1 in the distal section. And one patient with calculi in the distal ureteral section underwent ureteroscopie lithotripsy. Renal fistula tube was connected with a urine dynamic detector and irrigation was performed continuously through the ureteroscope at different pressures. The baseline intra-pelvic pressure (IPP0) and maximum intra-pelvie pressure (IPPmax) were recorded. Results The average IPP0 was (16.9±3.2) cm H2O. The IPP levels during the ureteroscopic lithotripsy [(172.6±32.2) cm H2O] were all significantly higher than the IPP0(all P<0.01). In response to the irrigation pump pressure of 100 mmHg, the IPPmax during the ureteroscopic lithotripsy in the distal, middle, and proximal ureter were 74.6,93.5, and (110.3±2.4) cm H2O respectively. When the irrigation pump pressure levels were 50, 100, and 200 mm Hg respectively the IPPmax levels during the ureteroscopic lithotripsy in the proximal ureter were (51.0±4.5), (110.3±2.4), and (193.2±5.9) cm H2O respectively (all P<0.01). Conclusion The renal pelvic pressure is signifieanfly increased during ureteroseopic lithotripsy. High renal pelvic pressure is associated with the irrigation pressure and the position of calculi.