目的 探讨微通道经皮肾镜取石术(PCNL)中体位对肾盂内压变化的影响.方法 选择在我院行PCNL的患者91例；根据手术体位的不同,将其分为3组(仰卧位,32例；侧卧位,30例；斜仰卧位,29例).将通过逆行置入肾盂的6F输尿管导管连接测压系统,保持平均灌注流量337 ml/min,平均灌注压176 mm Hg(1 mm Hg=0.133 kPa)；分别监测俯卧位、侧卧位与斜仰卧位三种不同体位PCNL术中肾盂内压的变化,每秒钟采集1次数据,作统计学分析.结果 俯卧位、侧卧位与斜仰卧位PCNL术中平均肾盂内压分别为(30.53±4.79)、(31.76±3.55)、(18.33±2.71) cm H2O(1 cm H2O=0.098 kPa).俯卧位和侧卧位PCNL术中平均肾盂内压差异无显著性(P＞0.05),而斜仰卧位PCNL术中平均肾盂内压明显低于俯卧位与侧卧位(P＜0.01).各组间结石清除率差异无显著性(P＞0.05).结论 不同体位PCNL术中肾盂内压均较低,小于引起肾实质返流的压力安全值( 40 cm H2O).斜仰卧位PCNL术中肾盂内压较低,而俯卧位与侧卧位PCNL术中肾盂内压无显著差异.%Objective To explore the affection of different body positions on intrapelvic pressure during percutaneous nephrolithotomy ( PCNL ).Methods Ninety-one patients who underwent PCNL at our hospital were studied,and these patients were divided into three groups based on their body position ( prone position,n=32; lateral position,n=30; obliqu.e supine position,n=29 ).An open-end 6 F ureteral catheter was inserted into the target ureter.The average irrigation fluid was about 337 ml/min;average irrigation pressure was 176 mm Hg ( 1 mm Hg=0.133 kPa ).Intrapelvic pressures were collected once per second with urodynamic work stations,and the data was analyzed.Results The average intrapelvic pressure of different positions during PCNL,prone position,lateral position,and oblique supine position,were ( 30.53 ± 4.79 ),( 31.76 ± 3.55 ),( 18.33 ± 2.71 ) cm H2O ( 1 cm H2O=0.098kPa ),respectively.Intrapelvic pressure of oblique supine position was significant lower than that of prone position and lateral position ( P ＜ 0.01 ),but there was no difference in intrapelvic pressure between prone position and lateral position ( P ＞ 0.05 ).Conclusions Intrapelvic pressures of different positions during PCNL were lower than the safety level ( 40 cmH2O ).The intrapelvic pressure of oblique supine position for PCNL was lower than that of prone and lateral position,but there were no significant difference in intrapelvic pressure between prone and lateral position.
展开▼
