肾结石微创手术中肾盂内压监测方法的研究进展
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摘要
肾结石是泌尿外科常见疾病,其发病率有增加趋势。随着医学设备的发展,其治疗的主流逐渐由传统手术向微创手术转变。通常在行肾结石微创手术时,为保持手术视野的清晰及冲出碎石,常进行肾盂冲洗灌注,但目前的规范操作仍然可能造成肾盂内压升高,导致含有细菌及内毒素的灌注液经肾返流吸收,引起术后发热及脓毒症。因此,持续有效地监控肾内压力,并将肾盂内压控制在一定水平,可降低肾返流的发生,提高肾结石微创手术的安全性。
Renal calculi are common diseases in department of urology, and their incidence is increasing. With the development of medical equipment, the mainstream of nephrolithotomy has gradually changed from traditional surgery to minimally invasive surgery. Usually, in the minimally invasive surgery of renal calculi, renal pelvis irrigation and perfusion are used to keep the surgical field clear and clear of the gravel. However, the current standard operation may still lead to renal pelvic pressure increasing, resulting in the absorption of perfusion with bacteria and endotoxin through renal regurgitation, causing postoperative fever and sepsis. Therefore, continuous and effective monitoring of intrarenal pressure, and control of the renal pelvis pressure to a certain level can reduce the occurrence of renal regurgitation and improve the safety of minimally invasive surgery of renal calculi.
Renal calculi are common diseases in department of urology, and their incidence is increasing. With the development of medical equipment, the mainstream of nephrolithotomy has gradually changed from traditional surgery to minimally invasive surgery. Usually, in the minimally invasive surgery of renal calculi, renal pelvis irrigation and perfusion are used to keep the surgical field clear and clear of the gravel. However, the current standard operation may still lead to renal pelvic pressure increasing, resulting in the absorption of perfusion with bacteria and endotoxin through renal regurgitation, causing postoperative fever and sepsis. Therefore, continuous and effective monitoring of intrarenal pressure, and control of the renal pelvis pressure to a certain level can reduce the occurrence of renal regurgitation and improve the safety of minimally invasive surgery of renal calculi.
引文
[1]叶章群,刘浩然.泌尿系结石的诊断治疗进展[J].临床外科杂志,2017,25(2):85-88.
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[19]Alsmadi J,Fan J,Zhu W,et al.The influence of super-mini percutaneous nephrolithotomy on renal pelvic pressure in vivo[J].J Endourol,2018,32(9):819-823.
[20]龙兆麟,黄韬,廖春贤.标准通道与微创经皮肾镜取石术在不同肾盂压力下治疗鹿角形肾结石比较[J].实用医学杂志,2018,34(13):2217-2220.
[21]王志勇,李修明,马光,等.标准通道经皮肾镜碎石术中肾盂内压的改变及对肾小球滤过率的影响[J].中国内镜杂志,2018,24(1):11-16.
[22]刘海超,许长宝,赵兴华,等.注射器注水法输尿管软镜术中肾盂压力测定的安全性评价[J].中华泌尿外科杂志,2016,37(2):135-138.
[23]臧运江,辛秀英,路强.微创经皮肾取石术中肾盂内压力监测的意义[J].潍坊医学院学报,2010,32(5):383-385.
[24]Zhu X,Song L,Xie D,et al.Animal experimental study to test application of intelligent pressure control device in monitoring and control of renal pelvic pressure during flexible ureteroscopy[J].Urology,2016,91:242.e11-242.e15.
[25]邓小林,宋乐明,钟久庆,等.可智能监控肾盂内压的输尿管软镜吸引取石术的临床应用[J].中华泌尿外科杂志,2016,37(5):385-388.
[2]Wu C,Hua LX,Zhang JZ,et al.Comparison of renal pelvic pressure and postope rative fever incidence between standard-and mini-tract percutaneous nephrolithotomy[J].Kaohsiung J Med Sci,2017,33(1):36-43.
[3]Ferakis N,Stavropoulos M.Mini percutaneous nephrolithotomy in the treatment of renal and upper ureteral stones:lessons learned from a review of the literature[J].Urol Ann,2015,7(2):141-148.
[4]Zeng G,Wan S,Z hao Z,et al.Super-mini pereuta neous nephrolithotomy(SMP):a new concept in technique and instrumentation[J].BJU Int,2016,117(4):655-661.
[5]阿不力孜·司马义,阿卜力孜·阿塔吾拉,艾尼瓦尔·玉苏甫,等.B超引导下超微通道经皮肾镜取石术在治疗上尿路结石的应用[J].国际泌尿系统杂志,2018,38(1):80-83.
[6]阿不力孜·司马义,艾尼瓦尔·玉苏甫,王晨宇,等.B超引导下超微通道经皮肾镜取石术治疗小儿上尿路结石的效果分析[J].中华泌尿外科杂志,2016,37(4):262-264.
[7]Zhong W,Zeng G,Wu K,et al.Does a smaller tract in percutaneous nephrolithotomy contribute to high renal pelvic pressure and postoperative fever?[J].J Endourol,2008,22(9):2147-2151.
[8]汪前亮.输尿管软镜钬激光碎石手术中肾盂压力的研究进展[J].国际泌尿系统杂志,2016,36(6):935-938.
[9]汤晓晖,夏术阶,赵淮平,等.肾盂内压增高对肾损伤的实验研究[J].临床泌尿外科杂志,2012,27(1):61-63,67.
[10]Koras O,Bozkurt IH,Yonguc T,et al.Risk factors for postoperative infectious complications following percutaneous nephrolithotomy:a prospective clinical study[J].Urolithiasis,2015,43(1):55-60.
[11]陈亮,李建兴,黄晓波,等.一期经皮肾镜手术治疗无发热结石性脓肾术后发生全身炎症反应综合征的危险因素分析[J].北京大学学报(医学版),2014,46(4):566-569.
[12]钟志刚,潘铁军.微通道经皮肾镜取石术中肾盂内高压对机体的影响[J].临床外科杂志,2016,24(4):313-315.
[13]杨嗣星,郑府,柯芹,等.软性输尿管镜碎石术中肾盂内压力监测方法及意义[J].中华泌尿外科杂志,2014,35(8):575-578.
[14]Zhong W,Leto G,Wang L,et al.Systemic inflammatory response syndrome after flexible ureteroscopic lithotripsy:a study of risk factors[J].J Endourol,2015,29(1):25-28.
[15]de la Rosette J,Denstedt J,Geavlete P,et al.The clinical research office of the endourological society ureteroscopy global study:indications,complications,and outcomes in11,885 patients[J].J Endourol,2014,28(2):131-139.
[16]钱冲,党博文,谭宝飞,等.输尿管软镜术肾盂内压的测定与术后发热的关系[J].局解手术学杂志,2018,27(5):342-346.
[17]陈松宁,唐浩,陆彩连,等.输尿管软镜碎石术中监测肾盂压力的临床意义[J].中国医药科学,2016,6(9):191-193.
[18]段康,刘齐贵,王跃力,等.软镜碎石术中肾内压监测的方法及意义(附13例报告)[J].西南国防医药,2016,26(2):126-129.
[19]Alsmadi J,Fan J,Zhu W,et al.The influence of super-mini percutaneous nephrolithotomy on renal pelvic pressure in vivo[J].J Endourol,2018,32(9):819-823.
[20]龙兆麟,黄韬,廖春贤.标准通道与微创经皮肾镜取石术在不同肾盂压力下治疗鹿角形肾结石比较[J].实用医学杂志,2018,34(13):2217-2220.
[21]王志勇,李修明,马光,等.标准通道经皮肾镜碎石术中肾盂内压的改变及对肾小球滤过率的影响[J].中国内镜杂志,2018,24(1):11-16.
[22]刘海超,许长宝,赵兴华,等.注射器注水法输尿管软镜术中肾盂压力测定的安全性评价[J].中华泌尿外科杂志,2016,37(2):135-138.
[23]臧运江,辛秀英,路强.微创经皮肾取石术中肾盂内压力监测的意义[J].潍坊医学院学报,2010,32(5):383-385.
[24]Zhu X,Song L,Xie D,et al.Animal experimental study to test application of intelligent pressure control device in monitoring and control of renal pelvic pressure during flexible ureteroscopy[J].Urology,2016,91:242.e11-242.e15.
[25]邓小林,宋乐明,钟久庆,等.可智能监控肾盂内压的输尿管软镜吸引取石术的临床应用[J].中华泌尿外科杂志,2016,37(5):385-388.