输尿管上段结石两种麻醉方法的前瞻性随机对照研究(附视频)

Two different anesthesia methods for upper ureteral calculi: a prosective randomized controlled study

目的比较腰硬联合麻醉（CSEA）和全身麻醉（GA）下输尿管镜钬激光碎石取石术治疗输尿管上段结石的有效性和安全性。方法2010年10月至2012年3月，输尿管上段结石患者（结石大小1．2cm），密闭信封法分为CSEA、GA两组。记录两组患者年龄、性别、ASA分级、病史和结石大小等临床资料。观察比较患者术中血压、心率、血氧饱和度、疼痛不适程度，术者操作难易程度，结石返回肾脏率、术后并发症以及住院总费用。结果194例输尿管上段结石患者，CSEA组（n：89）和GA组（n=105），两组患者一般临床资料无统计学差异，术中两组患者生命体征均维持在正常范围内，氧饱和度变化无统计学意义（P〉0．05）。CSEA组术中患者疼痛不适率，操作难度和结石返回肾脏率明显高于GA组（P〈0．05）。CSEA组3例术中发生输尿管穿孔，GA组无一例输尿管穿孔病例，但GA组住院总费用较CSEA组费用高（P〈0．05）。结论GA或CSEA均可用于输尿管镜钬激光碎石取石术治疗输尿管上段结石，但GA的有效性和安全性比CSEA更好。

Objective To compare the efficacy and safety of combined spinal-epidural anesthesia （CSEA） and general anesthesia （GA） for ureteroscopic lithotripsy with the holmium laser. Methods Between October 2010 and March 2012, patients with upper ureteral stone were randomly selected for CSEA or GA using envelopes and enrolled in this study. The clinical characteristics of patients as patients＇ blood pressure, heart rate, oxyhemoglobin saturation, operative difficulty and side-effects in these two groups were evaluated. Results The ureteroscopic procedure was completed successfully in 194 patients, 89 patients in CSEA group, 105 patients in GA group. No significant differences were found between the two groups of characteristics and changs of blood pressure, heart rate, oxyhemoglobin saturation during the operation. The patients in GA group had a statistically significant stone-free rate, lower operative difficulty and fewer operative side-effects compared with the other group （P〈0.05）. However, the hospitalization expenses of GA patients are significantly higher （P〈0.05）. Conclusion Both CSEA and EA are applicable to ureteroscopic lithotripsy with the holmium laser for upper ureteral calculi, GA is safer and more efficient than CSEA for this operation.