输尿管软镜碎石术中监测肾盂压力临床意义.docVIP

输尿管软镜碎石术中监测肾盂压力临床意义 　　[摘要] 目的 探讨肾盂内压力监测在输尿管软镜碎石术治疗肾结石中的临床意义。方法 分析55例患肾结石行输尿管软镜碎石术的患者，监测术中肾盂内压力，分为高压组和低压组。比较患者术前术后即刻，术后3、7、30d尿mALB变化，监测术后患者体温，疼痛程度。结果 两组术后即刻尿mALB水平明显高于术前，高压组升高更明显。低压组术后7d尿mALB可恢复至术前水平，高压组则需术后30d。高压组术后发热、疼痛程度明显高于低压组。结论 输尿管软镜碎石术中高压灌注可引起肾功能损害，实时监测肾盂内压力，有利于恢复肾脏滤过功能，有利于减少术后感染、疼痛等并发症。 　　[关键词] 输尿管软镜；肾盂内压；尿微量白蛋白；并发症 　　[中图分类号] R692.4 [文献标识码] B [文章编号] 2095-0616（2016）09-191-03 　　[Abstract] Objective To explore and discuss the clinical significance of monitoring the renal pelvic pressure in lithotripsy through flexible ureteroscope on treating kidney stones. Methods 55 kidney stones patients with lithotripsy through flexible ureteroscope were divided into high pressure group and low pressure group according to the renal pelvic pressure monitored in operation. The urine mALB level changes among preoperative and postoperative immediately， postoperative 3 days， 7 days and 30 days were compared， the postoperative body temperature and pain degree were monitored. Results The postoperative immediately urine mALB level of the two groups were significantly higher than that of the preoperative level. The high pressure group increased more significantly than that of the low pressure group. The urine mALB level of the low pressure group needed postoperative 7 days to recovery the preoperative level， while the high pressure group required postoperative 30 days. The postoperative fever and pain degree of the high pressure group were dramatically higher than that of the low pressure group. Conclusion The high pressure pouring in lithotripsy through flexible ureteroscope could cause renal function injury， the real-time monitoring of the renal pelvic pressure conducived to the recovery of renal filtration function and the reduction of postoperative infection， pain etc complications. 　　[Key words] Flexible ureteroscope； Renal pelvic pressure； Microalbuminuria in urine； Complication 　　随着内窥镜技术的进步和钬激光碎石术的发展，目前临床上绝大多数上尿路结石患者已无需行开放手术取石[1]。相对于人工建立取石通道的经皮肾镜碎石术，输尿管软镜可循人体自然腔道操作，为处理