Correlation between different renal pellis pressures and perioperative complications during percutaneous nephrolithotomy

doi:10.3877/cma.j.issn.1674-3253.2023.06.014

Abstract

Abstract:

Objective

To investigate the effect of different intrarenal pressures on perioperative complications in patients undergoing percutaneous nephrolithotomy (PCNL).

Methods

The clinical data of 189 cases of complex kidney stones who underwent PCNL in General Hospital of the Southern Theater Command of the People's Liberation Army of China from August 2017 to December 2019 were retrospectively analyzed. According to the intraoperative pressure measurement in the renal pelvis, the patients were divided into instant high pressure group, transient high pressure group and sustained high pressure group. The operation time, flushing volume, extravasation of perfusate, primary stone clearance rate and other indicators of patients in each group were analyzed; postoperative conditions of patients were compared and analyzed: postoperative fever, incidence of septic shock, postoperative Hb, HCT, Na⁺ decrease degree, postoperative blood WBC, PCT elevation and so on.

Results

There were significant differences in the extravasation of perfusate among the three groups, among which the instant high pressure group (8%) < transient high pressure group (18.4%) < sustained high pressure group (22.6%) (P< 0.05). The incidence of postoperative fever and septic shock, the degree of postoperative, HCT, Na⁺ decline, and the postoperative blood WBC and PCT elevations were statistically different among the three groups: instant high pressure group [20.69%, 2.30%, (0.09±0.01), (9.3±0.6), (2.6±0.2), (2.1±0.4)]< transient high pressure group [28.57%, 6.12%, (0.13±0.01), (12.3±0.9), (3.3±0.4), (5.2±1.7)]< sustained high pressure group [45.28%, 11.32%, (0.16±0.01), (13.8±0.9), (5.1±0.5), (9.8±1.8)] (P<0.05).

Conclusion

Long-term maintenance of high pressure in the renal pelvis during percutaneous nephrolithotomy can significantly increase the incidence of perioperative complications.

Key words: Kidney stones, Renal pelvis pressure, PCNL, Complication

zhi Cao, Xiwang Zhu, Wei Wang, Hui Zhang, Chenglin Yang, Xiaoming Zhang. Correlation between different renal pellis pressures and perioperative complications during percutaneous nephrolithotomy[J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(06): 616-620.

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References 22

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	例数	年龄[岁，(±s)]	BMI [kg/m²，(±s)]	性别（例）		患侧（例）		积水（例）
	例数	年龄[岁，(±s)]	BMI [kg/m²，(±s)]	男	女	左	右	无	轻	中	重
瞬时高压组	87	50±11	24±2	48	39	46	41	30	29	17	11
短暂高压组	49	48±13	23±2	25	24	27	22	19	16	8	6
持续高压组	53	52±14	24±2	29	24	34	19	15	20	9	9
统计值		H=0.773	H=0.171	χ²=0.234		χ²=1.767		Z=1.869
P值		0.418	0.081	0.890		0.413		0.931
	结石类型（例）			结石性质（例）		结石表面积[mm²，(±s)]	平均CT值[Hu，(±s)]	术前尿路感染（例）
	普通	部分铸型	铸型	感染	非感染	结石表面积[mm²，(±s)]	平均CT值[Hu，(±s)]	是	否
瞬时高压组	56	20	11	14	73	975±575	930±135	51	36
短暂高压组	27	13	9	8	41	1 023±6160.	915±113	29	20
持续高压组	24	17	12	10	43	1 041±6120.	905±118	33	20
统计值	χ²=5.199			χ²=0.198		H=0.345	H=1.184	χ²=0.192
P值	0.268			0.906		0.841	0.553	0.909

	例数	年龄[岁，(±s)]	BMI [kg/m²，(±s)]	性别（例）		患侧（例）		积水（例）
	例数	年龄[岁，(±s)]	BMI [kg/m²，(±s)]	男	女	左	右	无	轻	中	重
瞬时高压组	87	50±11	24±2	48	39	46	41	30	29	17	11
短暂高压组	49	48±13	23±2	25	24	27	22	19	16	8	6
持续高压组	53	52±14	24±2	29	24	34	19	15	20	9	9
统计值		H=0.773	H=0.171	χ²=0.234		χ²=1.767		Z=1.869
P值		0.418	0.081	0.890		0.413		0.931
	结石类型（例）			结石性质（例）		结石表面积[mm²，(±s)]	平均CT值[Hu，(±s)]	术前尿路感染（例）
	普通	部分铸型	铸型	感染	非感染	结石表面积[mm²，(±s)]	平均CT值[Hu，(±s)]	是	否
瞬时高压组	56	20	11	14	73	975±575	930±135	51	36
短暂高压组	27	13	9	8	41	1 023±6160.	915±113	29	20
持续高压组	24	17	12	10	43	1 041±6120.	905±118	33	20
统计值	χ²=5.199			χ²=0.198		H=0.345	H=1.184	χ²=0.192
P值	0.268			0.906		0.841	0.553	0.909

	例数	手术时间[min，(±s)]	灌注量[L，(±s)]	灌注液外渗[例(%)]	Ⅰ期结石清除率[例(%)]	术后发热[例(%)]
瞬时高压组	87	104±6	16±5	7(8.05)	74(85.06)	18(20.69)
短暂高压组	49	0105±10	16±5	09(18.37)	38(77.55)	14(28.57)
持续高压组	53	104±7	16±6	12(22.64)	34(64.15)	24(45.28)
统计值		H=0.590	H=0.734	χ²=6.220	χ²=6.060	χ²=9.590
P值		0.745	0.693	0.045	0.048	0.008
	术后Hb下降值[g/L，(±s)]	术后HCT下降值(±s)	术后血Na⁺下降值[mmol/L，(±s)]	术后血WBC升高值[×10⁹，(±s)]	术后PCT升高值[ng/L，(±s)]	术后脓毒症性休克[例(%)]
瞬时高压组	21.1±1.1	0.09±0.01	9.3±0.6	2.6±0.2	2.1±0.4	2(2.30)
短暂高压组	22.9±1.5	0.13±0.01	12.3±0.9	3.3±0.4	5.2±1.7	3(6.12)
持续高压组	22.2±1.5	0.16±0.01	13.8±0.9	5.1±0.5	9.8±1.8	0.6(11.32)0
统计值	H=0.928	H=38.819	H=17.160	H=18.087	H=27.110	χ²=6.780
P值	0.629	<0.001	<0.001	<0.001	<0.001	0.028

	例数	手术时间[min，(±s)]	灌注量[L，(±s)]	灌注液外渗[例(%)]	Ⅰ期结石清除率[例(%)]	术后发热[例(%)]
瞬时高压组	87	104±6	16±5	7(8.05)	74(85.06)	18(20.69)
短暂高压组	49	0105±10	16±5	09(18.37)	38(77.55)	14(28.57)
持续高压组	53	104±7	16±6	12(22.64)	34(64.15)	24(45.28)
统计值		H=0.590	H=0.734	χ²=6.220	χ²=6.060	χ²=9.590
P值		0.745	0.693	0.045	0.048	0.008
	术后Hb下降值[g/L，(±s)]	术后HCT下降值(±s)	术后血Na⁺下降值[mmol/L，(±s)]	术后血WBC升高值[×10⁹，(±s)]	术后PCT升高值[ng/L，(±s)]	术后脓毒症性休克[例(%)]
瞬时高压组	21.1±1.1	0.09±0.01	9.3±0.6	2.6±0.2	2.1±0.4	2(2.30)
短暂高压组	22.9±1.5	0.13±0.01	12.3±0.9	3.3±0.4	5.2±1.7	3(6.12)
持续高压组	22.2±1.5	0.16±0.01	13.8±0.9	5.1±0.5	9.8±1.8	0.6(11.32)0
统计值	H=0.928	H=38.819	H=17.160	H=18.087	H=27.110	χ²=6.780
P值	0.629	<0.001	<0.001	<0.001	<0.001	0.028

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