摘要
目的:探讨刺激性利尿局部浸润麻醉下彩超引导微创经皮肾镜碎石取石术(mPCNL)治疗上尿路结石的可行性与安全性。方法:回顾性分析2017年7月-2019年6月行局部麻醉mPCNL的上尿路结石患者90例,男57例,女33例,年龄22~71岁,平均(38.3±10.7)岁。结石长径1.6~4.5 cm,平均(3.1±1.3)cm。术前30 min采用刺激性利尿人造肾积水,局部浸润麻醉下彩超引导行mPCNL,分别在术后0、6、24、48 h行视觉模拟评分(VAS)评估疼痛严重程度。对人口学特征、结石特征进行评价以确定手术可行性,对并发症进行评估以确定安全性,并评估无结石率以确定疗效;结果:术中局部麻醉效果均满意,所有病例均在局麻下完成手术。平均ASA评分(1.5±0.4)分,平均手术时间(56.0±25.8)min,术后0、6、24、48 h的VAS评分均值分别为2.5、2.2、1.6和0.7分,1例(1.1%)患者术后需行选择性肾动脉栓塞术,10例(11.1%)患者术后24 h内需镇痛治疗,无管化78例(86.7%),留置造瘘管12例(13.3%),平均留置时间(3.2±0.6)d,无管化患者术后平均住院(2.6±0.5)d,Ⅰ期结石清除率为92.2%(83/90)。结论:刺激性利尿人造肾积水后局部浸润麻醉下彩超引导穿刺行mPCNL,具有术前准备时间短、创伤小、并发症少、恢复快、结石清除率高等优点,可作为上尿路结石的治疗方法。
Objective:To explore the feasibility and safety of minimally invasive ultrasonography-guided percutaneous nephrolithotomy(mPCNL)for treating upper urinary calculi under local infiltration anesthesia accompanied with stimulated diuresis.Methods:A retrospective analysis was performed on the clinical data of 90 patients who suffered from upper urinary calculi and underwent mPCNL with local anesthesia from July 2017 to June 2019,including57 males and 33 females with the age ranging from 22 to 71 years old(mean 38.3±10.7 years old).The long diameter of the calculi ranged from 1.6 to 4.5 cm,with an average of(3.1±1.3)cm.At 30 min preoperation,diuretic was given to produce artificial hydronephrosis.Under the local infiltration anesthesia,ultrasonography-guided percutaneous punctures for mPCNL were carried out.Visual analogue scale(VAS)was used to assess the severity of pain at0,6,24 and 48 h postoperatively.The demographic characteristics and the stone characteristics were evaluated to determine the feasibility.The complications were evaluated to determine the safety.The stone-free rate was evaluated to determine the effectiveness.Results:The effect of local anesthesia during operation was satisfactory,and all cases were operated under local anesthesia.The mean ASA score was(1.5±0.4).The mean operative time was(56±25.8)min.The mean VAS scores at 0,6,24 and 48 h postoperatively were 2.5,2.2,1.6 and 0.7 respectively,one patient(1.1%)required selective renal angioembolism,10 patients(11.1%)received analgesic treatment after operation within 24 h,78 patients(86.7%)were not given drainage tube,12 patients(13.3%)were given drainage tube,and average retention time was(3.2±0.6)days.The average length of stay after surgery was(2.6±0.5)days for tubeless patients.Stone-free rate(SFR)of the first stage was 92.2%(83/90).Conclusion:By diuretic to produce artificial hydronephrosis,ultrasonography-guided percutaneous nephrolithotomy under the local infiltration anesthesia for mPCNL has the advantages of shorter preoperative preparation time,less trauma,lower incidence of complications,quicker recovery,and higher stone-free rate,and can be used as a treatment for upper urinary calculi.
作者
郑亮亮
匡仁锐
邓君
李金
刘伟
龚智娴
刘梅
张学宏
汪隆旺
ZHENG Liangliang;KUANG Renrui;DENG Jun;LI Jin;LIU Wei;GONG Zhixian;LIU Mei;ZHANG Xuehong;WANG Longwang(Department of Urology,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Day Care,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Anesthesiology,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Urology,Nanchang County People's Hospital,Nanchang 330006,China)
出处
《微创泌尿外科杂志》
2020年第4期240-244,共5页
Journal of Minimally Invasive Urology
基金
江西省卫生计生委科技计划(编号20185199)
关键词
微创经皮肾镜取石术
局部麻醉
刺激性利尿
人造肾积水
无管化
minimally invasive percutaneous nephrolithotomy
local anesthesia
stimulated diuresis
artificial renal hydronephrosis
tubeless
