| 孙丰 魏海彬 孙晓文 王悦童 沙明磊 张琦 鲁军 邵怡.上尿路腔内手术中降低肾盂压力机制与方法的研究进展[J].,2014,14(23):4578-4581 |
| 上尿路腔内手术中降低肾盂压力机制与方法的研究进展 |
| The Research Progress of Reducing Pelvic Pressure in Endoluminal Operation of Upper Urinary Tract |
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| DOI： |
| 中文关键词: 上尿路 腔内 肾盂压力 |
| 英文关键词: Upper urinary tract Endoluminal irrigation Pelvic pressure |
| 基金项目:国家自然科学基金青年基金项目（81200504） |
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| 中文摘要: |
| 1983 年，Wickham 教授首先提出微创外科（minimally invasive surgery)，此后，微创泌尿外科逐渐成外具有科学意义上的微
创外科学的一个重要的分支学科。上尿路的腔内手术，包括PNL (Percutaneous nephrolithotomy)、URS(Ureteroscopic)、f-URS
(Flexible ureteroscope)等。与传统手术相比，上尿路的腔内手术具有创伤小、时间短、恢复快、并发症少，并且可以直视下进行手术
操作，临床应用较广泛。在腔内操作时，为保证术中手术视野的清晰度，手术多采用生理盐水（NS）进行灌注，进而导致肾盂压力升
高，引起各项潜在的危害。因此如何在上尿路腔内手术中降低肾盂压力成为一个研究的热点。近些年，腔内器械的改进，包括镜体
灌注通道入路与出路的分开设计、回流鞘的设计、压力泵的改进，在一定程度上降低了肾盂压力。灌注液体中加入相应浓度的药
物，抑制上尿路平滑肌的蠕动与收缩，也在一定程度上降低了肾盂压力。本文介绍了上尿路腔内手术中肾盂压力的影响因素，回
顾了肾盂压力升高后的危害，分析了肾盂压力升高机制，总结了肾盂压力降低的各种方案以及将来的应用前景。 |
| 英文摘要: |
| In 1983, Professor Wickhamwas the first to propose “Minimally Invasive Surgy”. Then Minimally Invasive Urology
became an important branch of Minimally Invasive Surgy. Endoluminal operation of upper urinary tract includes PNL ( Percutaneous
Nephrolithotomy ), URS ( Ureteroscopic ), f-URS ( Flexible ureteroscope ), etc. Compared with conventional surgery, endoluminal
operation, has advantages of shorter time, quicker recovery, fewer complications and under direct vision, and thus is applied widely in
clinic. In order to ensure the clarity of the operative vision, taking isotonic saline (NS) solution as irrigation fluid increases pelvic
pressure, which may causes potential hazards. Therefore, how to reduce pelvic pressure during endoluminal operation becomes a hot
topic. In recent years, endoluminal operative devices improvements, including newly developed continuous-flow ureterorenoscope,
ureteral access sheaths and pressure pump, have reduced pelvic pressure in a certain degree. Adding drug into the irrigation liquid,
inhibits peristalsis and contraction of smooth muscle and reduces the pelvic pressure. This article focuses on the factors affecting
intrapelvic pressure, analyzes the renal pelvic pressure elevated mechanism and hazards, and summarizes various schemes to reduce
pelvic pressure and future prospects. |
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