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目的介绍一种输尿管镜碎石术中测量输尿管腔内压的方法,并评价其临床应用价值。方法以44例输尿管上段结石患者为研究组,其中急性梗阻21例,慢性梗阻23例;以22例无结石梗阻但需行输尿管镜检的患者为对照组。碎石术中置输尿管镜于结石上方输尿管段,关闭灌注液,镜尾部连接延长管至压力换能器,结石上方输尿管腔内的液体压力即可转换为数字压力值。对压力值与梗阻时间、结石上方输尿管长径、肾盂积水深度、血肌酐浓度、每微升尿白细胞数等作相关分析。结果急性、慢性梗阻亚组及对照组输尿管腔内压分别为74.5mmHg(22～180)、32.5mmHg(9～53)、10.2mmHg(8～13)(1mmHg=0.133kPa)。研究组输尿管压力值与梗阻时间(r=0.985)、结石上方输尿管径(r=0.878)、肾盂积水深度(r=0.862)有明显相关关系,与血肌酐(r=0.214)、尿白细胞数(r=0.047)无明显相关关系。慢性梗阻亚组的输尿管压力值与患侧肾小球滤过率有明显的相关性(r=0.975)。结论本法简便无创伤性,可实时、量化测定输尿管腔内压力,对评估输尿管结石造成的上尿路梗阻程度有一定的应用价值。
Objective To introduce a method of measuring intraurethral pressure of ureter in ureteroscopic lithotripsy and to evaluate its clinical value. Methods Totally 44 patients with upper ureteral calculi were included in the study, including 21 cases of acute obstruction and 23 cases of chronic obstruction. Twenty-two patients without obstruction of stones underwent ureteroscopy as the control group. Lithotripsy ureteroscopy at the top of the ureter in the stone, close the perfusion fluid, the end of the mirror connected extension tube to the pressure transducer, the ureteral calculi above the liquid pressure can be converted into digital pressure value. Correlation analysis was made between the pressure value and obstruction time, the length of ureter above the calculus, the depth of hydronephrosis, the concentration of serum creatinine, the number of urine leukocytes per microliter. Results The ureteral lumen pressure in subgroup and control group was 74.5mmHg (22-180), 32.5mmHg (9-53) and 10.2mmHg (8-13) (1mmHg = 0.133kPa) respectively. The ureter pressure in the study group was significantly correlated with the obstruction time (r = 0.985), ureteral calculus above the calculi (r = 0.878) and hydronephrosis depth (r = 0.862) (r = 0.047) no significant correlation. There was a significant correlation between ureteral pressure in patients with chronic obstruction and glomerular filtration rate in affected side (r = 0.975). Conclusion This method is simple and noninvasive, real-time and quantitative measurement of ureteral lumen pressure, and has certain value in evaluating the degree of upper urinary tract obstruction caused by ureteral calculi.