局麻经皮肾镜取石术治疗上尿路结石  

Percutaneous nephrolithotomy under local infiltration anesthesia for upper urinary calculi

作　　者：翟建坡[1] 刘宁[1] 王海[1] 黄广林[1] 满立波[1] ZHAI Jianpo;LIU Ning;WANG Hai;HUANG Guanglin;MAN Libo(Department of Urology,Beijing Jishuitan Hospital,Beijing,100096,China)

机构地区：[1]北京积水潭医院泌尿外科,北京100096

出　　处：《临床泌尿外科杂志》2020年第8期635-637,共3页Journal of Clinical Urology

摘　　要：目的:筛选局麻经皮肾镜取石术的最佳适应人群。方法:收集我院泌尿外科2015年6月~2018年6月收治的肾或者输尿管结石,并行局麻经皮肾镜取石术的患者,共计226例。观察患者术中及术后的疼痛视觉模拟评分(visual analog pain scale,VAS)、手术结石清除率和手术并发症。并对术中VAS进行亚组分析。结果:患者在通道建立时疼痛最明显,VAS评分为3.2分。通道建立的VAS评分在高年龄(≥54岁)组为3分,在低年龄(<54岁)组为3.4分。两组比较差异有统计学意义(P=0.03)。VAS评分在肾结石组为3.1分,在输尿管结石组为3.2分,在复杂结石组为3.7分。3组之间两两比较差异有统计学意义(P=0.03)。VAS评分在单通道组为3分,在双通道组为3.2分,在三通道组为3.8分。3组之间两两比较差异有统计学意义(P=0.01)。本组患者经皮肾镜取石术的一期清石率在输尿管结石组为100%,在肾结石组为95%,在复杂性结石组为91%。2例患者需要输血,1例患者发生感染休克,无胸膜损伤和结肠损伤等发生,无围手术期死亡患者。结论:局麻能为经皮肾镜取石术提供良好的镇痛效果,尤其适用于单通道就可处理的肾盂或者输尿管单发结石。Objective:To screen the appropriate patients suitable for percutaneous nephrolithotomy(PCNL)under local anesthesia.Method:Two hundred and twenty six cases of renal or ureteral calculi receiving PCNL under local anesthesia were collected in the study.They were admitted to the department of urology,Beijing Jishuitan Hospital from June 2015 to June 2018.Visual analog pain scale(VAS)was recorded during and after the surgery.The stone-free rate and complications were also recorded.Intraoperative VAS was analyzed with subgroup.Result:The pain in establishing the tract was obvious with the VAS being 3.2.The VAS during the tract establishment was 3 in the older age(≥54 years)group,3.4 in the younger age(<54 years)group.The difference between the two groups was statistically significant(P=0.03).The VAS during the tract establishment was 3.1 in the renal calculi group,3.2 in the ureteral calculi group,and 3.7 in the complicated calculi group.The difference among the three groups was statistically significant(P=0.03).The VAS was 3 in single tract group,3.2 in double tracts group,and 3.8 in three tracts group.The difference among the three groups was statistically significant(P=0.01).In this study,the one stage stone-free rate after the PCNL was 100%in the ureteral calculi group,95%in the renal calculi group,and 91%in the complicated calculi group.Two patients required blood transfusion.One patient developed infective shock.No colon or pleura injury was detected and no one died.Conclusion:Local anesthesia provides good analgesic effect on PCNL,especially for renal pelvis or ureteral single stone that can be removed by single tract.

关 键 词：局部浸润麻醉 经皮肾镜取石术 肾结石 输尿管结石 

分 类 号：R692.4[医药卫生—泌尿科学]