Research progress of renal pelvic pressure monitor and control during percutaneous nephrolithotomy
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摘要: 肾结石是泌尿外科常见病之一,其发病率呈逐渐上升趋势。随着医疗腔镜技术的发展和设备的更新,肾结石的治疗已经由传统的开放手术转变为现代的微创手术。在行经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)治疗肾结石时,为了能使手术视野保持清晰以及将碎石冲出体外,通常需对肾盂进行灌注冲洗,但在灌注冲洗的过程中很容易出现肾盂内高压,导致含有细菌、内毒素等有害物质的冲洗液通过损伤的肾脏毛细血管及淋巴反流入血,轻者可引起发热,较重者可出现脓毒症,严重者可致感染性休克,对生命构成威胁。因此,实时动态地监测肾盂内压力(renal pelvic pressure,RPP),并精准地将RPP控制在安全范围内,可有效地降低肾内冲洗液反流发生的概率,从而提高手术安全性。本文旨在对PCNL术中监测及控制RPP的研究进展进行综述。Abstract: Renal stone is one of the common diseases in urology, and its incidence is gradually increasing. With the development of medical endoscopy technology and the renewal of equipment, the treatment of renal calculi has changed from traditional open surgery to modern minimally invasive surgery. When percutaneous nephrolithotomy(PCNL) is performed to treat renal calculi, it is usually necessary to irrigate the renal pelvis in order to maintain a clear field of vision and flush the crushed stone out of the body. But in the process of perfusion and flushing, it is easy to develop intrapelvic high pressure, resulting in the flow of washing fluid containing harmful substances such as bacteria and endotoxins into the blood through the injured renal capillaries and lymphatic regurgitation. And fever can be caused in mild cases. Sepsis can occur in severe cases. Septic shock can be caused in more serious cases, which poses a threat to life. Therefore, real-time and dynamic monitoring of renal pelvic pressure(RPP) and accurate control of RPP within a safe range can effectively reduce the probability of intra-renal lavage fluid reflux and improve the safety of operation. The purpose of this article is to review the research progress of monitoring and controlling RPP during PCNL.
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Key words:
- percutaneous nephrolithotomy /
- renal pelvic pressure /
- accurate control
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