局麻下非同步CT辅助联合超声定位微创经皮肾镜取石术治疗上尿路结石的效果  

Efficacy of nonsynchronous CT-assisted localization combined with ultrasound localized minimally invasive percutaneous nephrolithotomy under local anesthesia for upper urinary calculi

作　　者：张英晨 赵帅 孙浩 毕文浩 吴志强 成小建 蒋立城 ZHANG Yingchen;ZHAO Shuai;SUN Hao;BI Wenhao;WU Zhiqiang;CHENG Xiaojian;JIANG Licheng(Department of Urology,Zibo 148 th Hospital,Zibo 255300,Shandong,China;Department of Urology,The NO.960 Hospital of PLA,Jinan 250031,Shandong,China)

机构地区：[1]淄博一四八医院泌尿外科,山东淄博255300 [2]解放军960医院泌尿外科,山东济南250031

出　　处：《山东大学学报（医学版）》2023年第10期46-50,57,共6页Journal of Shandong University:Health Sciences

摘　　要：目的探讨局麻下非同步CT辅助联合超声定位微创经皮肾镜取石术治疗上尿路结石的应用价值。方法对244例259侧上尿路结石患者术前模拟术中体位行CT扫描辅助定位,术中根据CT影像信息联合超声定位穿刺在局麻下行微创经皮肾镜取石术,观察患者术中疼痛视觉模拟评分(VAS)、结石取净率和手术并发症。结果术中局部麻醉效果满意,所有患者均在局麻下完成手术。疼痛评分1~3分112例(45.9%),4~6分117例(48.0%),7~9分15例(6.1%)。所有患者均成功建立经皮肾穿刺通道,手术时间40~160 min,平均92 min。患者总结石取净率为88.8%(230/259),其中输尿管上段结石为98.1%(102/104),单发肾结石93.9%(62/66),复杂性肾结石74.2%(66/89)。术后活动性出血2例,未发现肝脾、肠管、胸腔损伤等严重并发症。住院时间5~15 d,平均8.6 d。结论局麻下非同步CT辅助联合超声定位行微创经皮肾镜取石术简单、安全、高效、经济,值得临床推广应用。Objective To investigate the value of nonsynchronous CT-assisted localization combined with ultrasound localized minimally invasive percutaneous nephrolithotomy(MPCNL)under local anesthesia in the treatment of upper urinary calculi.Methods A total of 259 sides in 244 cases of upper urinary calculi underwent CT scan localization to simulate intraoperative posture before operation,and MPCNL was then successfully performed under local anesthesia.Visual analog scale(VAS),stone-free rate and complications were recorded.Results All cases were operated under satisfactory local anesthesia.The VAS was 1-3 in 112 cases(45.9%),4-6 in 117 cases(48%),and 7-9 in 15 cases(6.1%).Percutaneous puncture channels were successfully established in all patients.The operation time was 40-160 min,with an average of 92 min.The stone-free rate reached 88.8%(230/259)in all cases,98.1%(102/104)in the upper ureteral calculi group,93.9%(62/66)in the single renal calculi group,and 74.2%(66/89)in the complex renal calculi group.After operation,active bleeding occurred in 2 cases.No severe complications such as injury of liver,spleen,thorax or intestines were observed.The length of hospital stay was 5-15 d,with an average of 8.6 d.Conclusion Nonsynchronous CT-assisted localization combined with ultrasound localized MPCNL under local anesthesia is simple,safe,economical and effective,which justifies promotion in clinical practice.

关 键 词：局部麻醉 微创经皮肾镜取石术 CT扫描 超声引导 上尿路结石 

分 类 号：R692.4[医药卫生—泌尿科学]