The Investigation Of Perfusion Fluid Absorption In Flexible Ureteroscopy Lithotripsy With Or Without Negative Pressure Suction Ureteral Access Sheath

Objective(s):To estimate the absorption volume of perfusion fluid in patients undergoing flexible Ureteroscopy Lithotripsy(f-URL).And to explore whether the f-URL combined with patent negative pressure suction ureteral access sheath(UAS)can reduce the volume of perfusion fluid absorption.Methods:This study was performed in 62 patients with kidney stones or upper segment ureteral calculi from January 2017 to January 2018 in our hospital.All patients were treated with f-URL.According to whether the UAS have negative pressure suction,they are randomly divided into group A(no suction)and group B(with suction).We recorded the incipient Renal Pelvic Pressure(RPP),intraoperative RPP,the perfusion time,perfusion fluid intake and output,and then we calculated the volume of perfusion fluid absorption.Besides,all patients’ Heart Rate(HR),Arterial Pressure(MAP),Temperature(T)were recorded before and after the operation respectively.At the same time,all patients,Hemoglobin(Hb),Hematocrit(HCT),Serum electrolyte ions(Na+,K+,Cl-,Ca2+,HCO3-),Potential of Hydrogen(PH),Base Excess(BE)and Lactic acid(Lac)were also measured before and after the operation.Results:The initial RPP of group A and B was(9.94 ± 2.98)mmHg and(9.53± 3.08)mmHg,respectively.And no significant difference has been seen between the two groups(P = 0.62).The intraoperative average RPP significantly higher than initial RPP in group A(P<0.001).But in group B,the average RPP significantly lower than incipient RPP(P<0.001).The perfusion fluid absorption have been observed in both two groups.The average uptake of group A was(211.6 ± 83.2)ml in group A.But in group B,the average volume of fluid absorption was(92.2±32.6)ml,A>B(P<0.001).The perfusion fluid absorption rate was significantly higher in group A(P<0.001).In group A,the postoperative Hb,HCT and PH values were reduced(P<0.05),but the postoperative Lac values was elevated(P<0.001),compared to the values befor operation.The HR,MAP,T,serum electrolyte ions(Na+,K+,Cl-,Ca2+,HC03-)and BE levels did not significantly change during and after the operation(P>0.05).In group B,the postoperative Hg,HCT values were also reduced compared with preoperation(P<0.05).But the decent degree of Hg,HCT in group B was lower than those in group A(P<0.05).There were no significant changes in the HR,MAP,T,serum electrolyte ions(Na+,K+,Cl-,Ca2+,HCO3-)and PH,Lac,BE in group B(P>0.05).No significant difference has been seen in the changes of PH before and after surgery between two groups(P =0.79).But the Lac changes of group B was less than those in group A(P<0.001).In the two groups,there were 11 patients with chill after the operation,including 9 cases in group A and 2 cases in group B.It was statistically difference between A and B(X2= 4.89,P = 4.89).Conclusion(s):Perfusion fluid absorption occurred during f-URL.The volume of perfusion fluid absorption was related to the intraoperative RPP levels.The application of negative pressure suction UAS could reduce RPP levels obviously,keep the perfusion fluid flows unobstructed,and reduce the volume of perfusion fluid absorption.The absorption of perfusion fluid could lead to hemodilution and the trend towards metabolic acidosis.