The Compare Of Renal Pelvic Pressure When Using Minimal Invasive Percutaneous Nephrolithotomy With Different Postures To Treating Obstructive Stones During Surgery

Objective：By measuring the change of the renal pelvic pressure duringoperation by using the minimally invasive percutaneous nephroscope holmium laserlithotripsy treating obstructive calculi respectively using18Fr and20Fr peel-awaysheath under three positions, compared and analyzed the renal pelvicpressure.Understanded the security of the renal pelvic pressure by using theminimally invasive percutaneous nephroscope holmium laser lithotripsy treatingobstructive calculi, and compared the size of the renal pelvic pressure with differentpositions and different sheath.At the same time，compared the patients,tolerance inthe surgery with different position.Method: Selected the patients who had calculi with renal pelvis ureter outletobstruction (upper ureteric calculi, renal pelvis ureter calculi, multiple kidney stonesand mold kidney stones), during MPCNL used18Fr or20Fr peel-away sheathrandomly and adopted prone position or oblique prone position or lateral positionrandomly, using the pressure sensor measured the renal pelvic pressure inintraoperative, and using the ecg monitor recorded the data.Results：(1) MPCNL treated obstructed calculi with18Fr sheath in the prone position andoblique prone position and lateral position, the average renal pelvic pressure of eachgroup were27.53±3.58cmH2O and26.51±3.26cmH2O and21.65±2.97cmH2O.Eachgroups,average renal pelvic pressure is lower than the limit value(40cmH2O) whichwe generally believed to cause renal parenchyma regurgitation. Renal pelvic pressurein the prone position group is the highest and in the lateral position group is thelowest.Prone position and oblique prone position have no statistical difference (P=0.236), but they were significantly higher than the lateral position group (P=0.000,0.001), between them have statistical significance.(2) MPCNL treated obstructed calculi with20Fr sheath in the prone position andoblique prone position and lateral position, the average renal pelvic pressure of eachgroup were26.60±3.51cmH2O and25.27±3.25cmH2O and20.99±2.73cmH2O. Each groups,average renal pelvic pressure is lower than the limit value(40cmH2O) whichwe generally believed to cause renal parenchyma regurgitation. The renal pelvicpressure in the prone position group is the highest and in the lateral position group isthe lowest.Prone position and oblique prone position have no statistical difference (P=0.236), but they were significantly higher than the lateral position group (P=0.000,0.001), prone position and oblique prone position compared with lateral position havestatistical significance.(3) Using prone position and oblique prone position and lateral position duringMPCNL, the average renal pelvic pressure between18Fr and20Fr sheath had nostatistical significance (P=0.275, P=0.275, P=0.236).(4) Using prone position and oblique prone position and lateral position duringMPCNL, the surgical cases of the patients who had discomfort of breathing and thearea before the heart during operation was7,1,0. Oblique prone position comparedwith prone position had statistical significance (0.02<P <0.05), lateral positioncompared with prone position had significant statistical significance (0.005<P <0.01), oblique prone position compared with lateral position had no statisticalsignificance (0.2<P <0.4).Conclusion:(1) The lateral position can significantly reduce the renal pelvic pressure ofintranperative period during using minimally invasive percutaneous nephroscopeholmium laser lithotripsy treated obstructive calculi.(2) The renal pelvic pressure is lower than infusion liquid reflux pressure limit(40cmH2O)when used minimally invasive percutaneous nephroscope holmium laserlithotripsy treated of obstructive stone by prone position and oblique prone positionand lateral position.(3) The oblique prone position and lateral position can improve patients，tolerance during minimally invasive percutaneous nephroscope holmium laserlithotripsy.