局麻联合 CT 三维重建在二期经皮肾镜取石中的应用  

Application of local anesthesia combined CT three-dimensional reconstruction in the second phase of PCNL

作　　者：林阳彦 邱春明 杨勇 孙灿标 邹枫 李虎林[2] 

机构地区：[1]南海区第三人民医院泌尿外科,广东佛山528244 [2]南方医科大学珠江医院泌尿外科,广州510280

出　　处：《岭南现代临床外科》2016年第4期480-483,共4页Lingnan Modern Clinics in Surgery

摘　　要：目的：探讨局麻联合CT三维重建技术在二期经皮肾镜取石术中的临床应用价值及安全有效性。方法2012年1月至2015年11月,选取一期经皮肾镜取石术后结石残留的患者64例,采用CT 三维重建技术分析结石情况,局麻下行二期经皮肾镜清除残留结石,评估残石取净率及安全性,术中采用“0-10”疼痛强度量表评估疼痛程度。结果所有患者术中均可探及结石,结石取净60例,清除率为93.8%（60/64）,4例残石均小于4.0 mm；疼痛评分0~3分者54例（84.4%）、4~6分者7例（10.9%）、7~9分者3例（4.7%）,疼痛评分≥7分者再局部予1%盐酸利多卡因5~10 mL 或盐酸哌替啶50~70 mg 肌注后疼痛缓解,无因疼痛难以忍受停止手术操作者,无改开放性手术病例,术中未发生肾盂穿孔、肝脾、胸腔、肠管等脏器损伤,未出现感染性休克、气胸、大出血等严重并发症。术前术后血红蛋白、肾功能电解质变化无明显差异（P〉0.05）。结论在一期PCNL减轻肾结石负荷的情况下,局麻联合CT三维重建行二期经皮肾镜取石术可安全有效清除残余结石,可选择作为一期PCNL术后残留结石的治疗。Objective To explore the clinical value and safety of local anesthesia combined CT 3D reconstruction in the second phase of percutaneous nephrolithotomy. Methods Between January 2012 and November 2015, 64 cases of patients with residual stone after PCNL were selected, and analyzed by CT 3D reconstruction, and second phase of PCNL was performed under local anesthesia. The stone clearance rate, security and pain degree were assessed. Results Of 64 cases undergoing PCNL, the residual renal stones were removed completely in 60 cases （93.8%）, and 4 cases failed and the size of residual stones were less than 4.0 mm. Post-operative pain score included 54 cases in 0 to 3 points （84.4%）, 7 cases in 4 to 6 points of （10.9%）, and 3 cases in 7 to 9 points （4.7%）. No one was transferred to general anesthesia for operation due to unbearable pain or needed open surgery. No serious complications occurred in all patients. The hemoglobin level, renal function and serum electrolytes had not changed obviously. Conclusion Management of local anesthesia combined CT three dimensional reconstruction was safe to treating remove residual calculi in the second phase of PCNL.

关 键 词：局麻 CT三维重建 二期经皮肾镜取石 

分 类 号：R692.4[医药卫生—泌尿科学]