摘要
目的 探讨留置输尿管支架管对患者上尿路尿动力学、。肾盂压力指标的影响。方法 单侧肾结石和（或）输尿管结石患者41例，男28例，女13例，平均年龄47（20～72）岁。行微创经皮肾穿刺取石术（MPCNL）后留置4．7F支架管及16F肾造瘘管，术后无输尿管残留结石及明显肾积水者进行膀胱内恒流灌注，灌注流量为40ml／min时，记录储尿期、排尿期。肾盂压力、腹压、逼尿肌压力、膀胱压力的变化。结果静息状态下。肾盂压力（IPP0）、腹压（IAPO）、逼尿肌压力（DP0）、膀胱压力（BP0）分男U为（33．07±7．04）、（27．52±7．03）、（3．27±2．88）、（30．86±7．24）cmH2O（1cmH，0=0．098kPa）；储尿期最大膀胱容量时。肾盂压力（IPPvol）、腹压（IAPvol）、逼尿肌压力（DPvol）、膀胱压力（BPvol）分别为（39．44±7．33）、（31．11±7．34）、（10．72±6．56）、（41．61±10．34）cmH2O；排尿期最大膀胱压力时肾盂压力（IPPmax）、腹压（IAPmax）、逼尿肌压力（DPmax）、膀胱压力（BPmax）分别为（65．68±17．03）、（33．7士9．72）、（41．88±7．78）、（74．95±12．79）cmH2O。IPPo、IPPvol、IPPmax两两比较差异均有统计学意义（P〈O．01）。排尿过程中出现不同程度的患侧腰背部疼痛不适11例（27％）。该11例IPPmax为（87．08±14．59）cmH2O，显著高于无症状组30例的（57．83±9．45）cmH2O（P〈0．01）。41例排尿期。肾盂压力均〉40amH2O。结论 留置支架管后储尿期。肾盂压力轻度升高，排尿期。肾盂压力明显升高，肾盂压力反复升高可能造成肾功能损害。在可能的情况下尽量不放置支架管，治疗结束后尽早拔除。
Objective To explore the effects of ureteral stent on renal pelvic pressure and other urodynamic parameters. Methods Forty one patients, 28 males and 13 females, with unilateral renal calculi and/or ureteral calculi were recruited in this study. The mean patient age was 47 years old （ranging from 20 to 72 years old）. All cases were placed a 4.7 F ureteral stent and 16 F nephrostomy tube after minimal invasive percutaneous nephrolithotomy （MPCNL）. There was no hydronephrosis and residual crushed stone in the ureter after MPCNL in all cases. Renal pelvic pressure, intra-abdo- minal pressure, detrusor pressure, bladder pressure changes during the filling and voiding phases with intravesical perfusion flow rate of 40 ml/min were recorded and analyzed. Results At the baseline, IPP0, IAP0, DP0 and BP0 were （33.1±17.0）cm H20, （27.5±7.0）cm H20, （3.3±2.9）cm H20 and （30.9±7.2）cm H20, respectively;At the maximum cystometric capacity during the filling phase, IPPvol, IAPvol, DPvol and BPvol were （39. 4±7. 3）cm H20, （31. 1±7. 3）cm H2O, （10. 7±6. 6） cm H2O and （41.6±10.3）cm H2O, respectively;At the maximum bladder pressure during the voi dingphase, IPP IAP DPmax and BPmax were （65. 7±17. 0）cm H2O, （33. 7±9. 7）cm H2O, （41.9±7.8）cm H20：and （75.0±12.8）cm H2O, respectively;There were statistical significance comparing between any of IPP0, IPPvol and IPPmax （P〈0.01）. 27%（11/41）patients were with the pain in kidney area at voiding IPPmax （87. 1±14. 6）cm H2O, which was significantly higher than IPPmax （57.8±9.5）cm H2O of asymptomatic group （30 patients） （P〈0.01）. In all cases, the renal pelvic pressure was higher than 40 cm H2O during the voiding phase. Conclusions Renal pelvic pressure increases during the filling phase after placing the ureteral stent, especially during the voiding phase. As renal function will be damaged by the high renal pelvic pressure, we should decrease the utilization of ureteral stent if possible. It is encouraged to remnvo the ureternk stent as early as possible.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2008年第7期466-469,共4页
Chinese Journal of Urology
