Zhong Wen, Zeng Guohua, Wu Kaijun, Li Xun, Chen Wenzhong, Yang Houmeng
Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China.
J Endourol. 2008 Sep;22(9):2147-51. doi: 10.1089/end.2008.0001.
High renal pelvic pressure brings systemic absorption of irrigation fluid containing bacteria or endotoxins, which leads to postoperative fever. We inspected the renal pelvic pressure (RPP) in vivo during minimally invasive percutaneous nephrolithotomy (MPCNL) to investigate whether a 14- to 18-French percutaneous tract and perfusion would bring high RPP and postoperative fever.
Between July 2005 and December 2007, 80 patients were selected for RPP measurement during MPCNL. The RPP was measured by a baroceptor connected to the open-ended ureteric catheter, which was indwelling retrogradely in the renal pelvic. A computer recorded the RPP each second, and all the data were evaluated statistically with SPSS 12.0 software.
During MPCNL with 14-, 16-, 18-, and double-16-French percutaneous tracts, the mean RPP was 24.55, 16.49, 11.22, and 6.64 mm Hg, respectively. Logistical analysis suggested that postoperative fever did not correlate to gender (P = 0.195), age (P = 0.641), urinary tract infection (P = 0.663), white blood cell > or = 10 x 10(9)/L in routine postoperative blood examination (P = 0.751), or an occurrence of renal pelvic pressure > or = 30 mm Hg in the operation (P = 0.662), although infection calculi (P = 0.000), percutaneous tract (P = 0.029), mean RPP (P = 0.036), mean RPP > or = 20 mm Hg (P = 0.013), accumulated time of RPP > or = 30 mm Hg (P = 0.010), and RPP > or = 30 mm Hg longer than 50 s (P = 0.024) may contribute a postoperative fever.
Renal pelvic pressure generally remains lower than the backflow level (30 mm Hg) during MPCNL via a 14- to 18-French percutaneous tract. Any factors that brought about poor drainage would result in temporarily elevated RPP greater than 30 mm Hg, and many such occurrences of high pressure would have an accumulating effect, which means enough backflow to cause bacteremia and postoperative fever.
肾盂高压会导致含细菌或内毒素的冲洗液发生全身吸收，进而引发术后发热。我们在微创经皮肾镜取石术（MPCNL）过程中对体内肾盂压力（RPP）进行了检测，以研究14至18法式经皮通道及灌注是否会导致高RPP及术后发热。
2005年7月至2007年12月期间，选取80例患者在MPCNL过程中进行RPP测量。通过连接开放式输尿管导管的压力感受器测量RPP，该导管逆行留置在肾盂内。计算机每秒记录一次RPP，所有数据用SPSS 12.0软件进行统计学评估。
在采用14法式、16法式、18法式及双16法式经皮通道的MPCNL过程中，平均RPP分别为24.55、16.49、11.22及6.64 mmHg。逻辑分析表明，术后发热与性别（P = 0.195）、年龄（P = 0.641）、尿路感染（P = 0.663）、术后常规血液检查中白细胞≥10×10⁹/L（P = 0.751）或手术中肾盂压力≥30 mmHg的发生情况（P = 0.662）无关，尽管感染性结石（P = 0.000）、经皮通道（P = 0.029）、平均RPP（P = 0.036）、平均RPP≥20 mmHg（P = 0.013）、RPP≥30 mmHg的累计时间（P = 0.010）以及RPP≥30 mmHg持续超过50秒（P = 0.024）可能会导致术后发热。
在通过14至18法式经皮通道进行的MPCNL过程中，肾盂压力一般保持低于反流水平（30 mmHg）。任何导致引流不畅的因素都会使RPP暂时升高超过30 mmHg，且多次出现这种高压情况会产生累积效应，即足以引起菌血症和术后发热的反流。
