發(fā)布時(shí)間：2018-09-03 14:10

【摘要】：目的：探索家豬輸尿管軟鏡操作手術(shù)中腎盂內(nèi)壓40cmH2O時(shí)對(duì)應(yīng)的灌注壓力。方法：家豬20只，處死后立即顯露泌尿系統(tǒng)，40個(gè)腎臟隨機(jī)分成4組。前3組自膀胱內(nèi)輸尿管口先插入F14/12輸尿管擴(kuò)張鞘（留置位置分別為輸尿管下段、中段），然后分別插入F7、F8、F9輸尿管軟鏡到達(dá)腎盂；第4組不插入輸尿管擴(kuò)張鞘，直接插入F8輸尿管軟鏡達(dá)腎盂。40個(gè)腎臟均用18G腎穿刺針行腎穿刺達(dá)腎盂，接Philips測(cè)壓裝置，，測(cè)量腎盂內(nèi)壓。3L袋裝生理鹽水懸掛不同高度進(jìn)行灌注，灌注管在腎臟水平通過“三通”接Philips測(cè)壓裝置。記錄不同情況下腎盂內(nèi)壓10、20、30、40、50cmH2O時(shí)對(duì)應(yīng)的灌注壓力。結(jié)果：腎盂內(nèi)壓10cmH2O，且使用F14/12輸尿管擴(kuò)張鞘，并留置于輸尿管中段時(shí)，F(xiàn)7、F8、F9輸尿管軟鏡所對(duì)應(yīng)的灌注壓力分別是29.70±0.949、27.50±2.068和24.10±1.792cmH2O；腎盂內(nèi)壓10cmH2O，F(xiàn)8輸尿管軟鏡不使用F14/12輸尿管擴(kuò)張鞘時(shí)，所對(duì)應(yīng)的的灌注壓力是10.10±1.853cmH2O。腎盂內(nèi)壓20cmH2O，且使用F14/12輸尿管擴(kuò)張鞘，并留置于輸尿管中段時(shí)，F(xiàn)7、F8、F9輸尿管軟鏡所對(duì)應(yīng)的灌注壓力分別是41.70±1.160、39.70±2.003和36.202±.004cmH2O；腎盂內(nèi)壓20cmH2O，F(xiàn)8輸尿管軟鏡不使用F14/12輸尿管擴(kuò)張鞘時(shí)，所對(duì)應(yīng)的的灌注壓力是22.10±1.853cmH2O。腎盂內(nèi)壓30cmH2O，且使用F14/12輸尿管擴(kuò)張鞘，并留置于輸尿管中段時(shí)，F(xiàn)7、F8、F9輸尿管軟鏡所對(duì)應(yīng)的灌注壓力分別是53.80±1.229、51.90±1.663和48.30±1.947cmH2O；腎盂內(nèi)壓30cmH2O，F(xiàn)8輸尿管軟鏡不使用F14/12輸尿管擴(kuò)張鞘時(shí)，所對(duì)應(yīng)的的灌注壓力是34.10±1.853cmH2O。腎盂內(nèi)壓40cmH2O，且使用F14/12輸尿管擴(kuò)張鞘，并留置于輸尿管中段時(shí)，F(xiàn)7、F8、F9輸尿管軟鏡所對(duì)應(yīng)的灌注壓力分別是66.10±1.197、64.20±1.398和60.60±2.066cmH2O；腎盂內(nèi)壓40cmH2O，F(xiàn)8輸尿管軟鏡不使用F14/12輸尿管擴(kuò)張鞘時(shí)，所對(duì)應(yīng)的的灌注壓力是46.40±1.776cmH2O。腎盂內(nèi)壓50cmH2O，且使用F14/12輸尿管擴(kuò)張鞘，并留置于輸尿管中段時(shí)，F(xiàn)7、F8、F9輸尿管軟鏡所對(duì)應(yīng)的灌注壓力分別是77.80±1.317、76.30±1.703和72.30±2.406cmH2O；腎盂內(nèi)壓50cmH2O，F(xiàn)8輸尿管軟鏡不使用F14/12輸尿管擴(kuò)張鞘時(shí)，所對(duì)應(yīng)的的灌注壓力是58.30±1.947cmH2O。結(jié)論：隨著灌注壓力的升高，腎盂內(nèi)壓逐漸升高；維持腎盂內(nèi)壓40cmH2O時(shí)，灌注壓力與輸尿管軟鏡外徑、輸尿管擴(kuò)張鞘及其留置位置有關(guān)系；F7輸尿管軟鏡結(jié)合留置于輸尿管中段的F14/12輸尿管擴(kuò)張鞘，最能保持出水通道暢通，維持腎盂內(nèi)壓40cmH2O時(shí)，所需灌注壓力可達(dá)到66.10±1.197，最有利于手術(shù)的進(jìn)行，保持手術(shù)視野清晰。
[Abstract]:Objective: To explore the corresponding perfusion pressure of 40 cm H2O in pigs undergoing flexible ureteroscopic operation. Methods: 20 pigs were sacrificed and exposed immediately to the urinary system. 40 kidneys were randomly divided into 4 groups. No F7, F8, F9 ureteroscope was inserted into the renal pelvis; group 4 did not insert the dilated sheath of the ureter, but directly inserted the F8 ureteroscope into the renal pelvis. Results: The perfusion pressures of F7, F8, F9 ureteroscopes were 29.70 (+0.949), 27.50 (+2.068) and 24.10 (+1.068) respectively when the intrapelvic pressure was 10 cm H2O and the F14/12 ureter sheath was dilated and placed in the middle ureter. The corresponding perfusion pressure was 10.10 [1.853] cmH2O. The intrapelvic pressure was 20 cmH2O, and the perfusion pressure was 41.70 [1.160] and 39.70 [2.003] respectively when the intrapelvic pressure was 10.10 [1.853] cmH2O] and the intrapelvic pressure was 10.10 [1.853] cmH2O] respectively. When the intrapelvic pressure was 20 cm H2O and the F8 ureteroscope did not use the F14/12 ureteral dilatation sheath, the corresponding perfusion pressure was 22.10+1.853 cm H2O. The intrapelvic pressure was 30 cm H2O, and when the F14/12 ureteral dilatation sheath was used and kept in the middle segment of the ureter, the corresponding perfusion pressure of the F7, F8 and F9 ureteroscopes was 53.80+1.229, respectively. The corresponding perfusion pressure was 34.10 (+ 1.853) cm H2O. The intrapelvic pressure was 40 cm H2O, and the perfusion pressure was 6 for F7, F8 and F9 ureteroscopes when they were placed in the middle segment of the ureter. When the intrapelvic pressure was 40 cm H2O and the F8 ureteroscope did not use the F14/12 ureteral dilatation sheath, the corresponding perfusion pressure was 46.40+1.776 cm H2O. The perfusion pressures were 77.80 [1.317], 76.30 [1.703] and 72.30 [2.406] cmH2O, respectively. The perfusion pressures were 58.30 [1.947] cmH2O when the intrapelvic pressure was 50 cm H2O and the F8 ureteroscope did not use the F14/12 ureteral dilatation sheath. F7 ureteroscope combined with F14/12 ureteral dilatation sheath in the middle ureter can keep the effluent passage unobstructed and maintain the intrapelvic pressure of 40 cm H2O, the required perfusion pressure can reach 66.10 (+ 1.197), which is most conducive to the operation and keep the surgical field clear.
【學(xué)位授予單位】：寧波大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R699.4

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