B超引导下局麻经皮肾镜取石术治疗上尿路结石的临床应用

Curative effects of percutaneous nephrolithotomy on treatment of upper urinary calculi under local anesthesia

目的 探讨B超引导下局麻经皮肾镜取石术（PCNL）治疗上尿路结石的可行性和安全性.方法 回顾性分析2008年3月-2012年10月B超引导下局麻行PCNL的86例患者的临床资料,其中复杂性肾结石16例、单纯肾盂结石52例、输尿管上段结石18例.在B超定位下选择中盏或结石所在肾盏处作肾穿刺点,用1％盐酸利多卡因10～ 40 ml自穿刺点向肾脏方向穿刺浸润麻醉,深达肾包膜.然后在B超引导行PCNL.结果 86例患者麻醉效果满意,均顺利完成手术.穿刺成功率100％（86/86）,术中未发现肝、脾、胸膜、肠管损伤等严重并发症.单纯肾盂结石患者结石取尽率96.2％（50/52）;结石残留2例,予体外冲击波碎石术（ESWL）排出.输尿管上段结石患者结石取尽率100％（18/18）.复杂性肾结石患者结石取尽率81.3％（13/16）;术后结石残留3例,行二期PCNL取石2例,予ESWL排出1例.所有患者均获随访3～12个月,平均8.5个月.随访期间未发现结石残余和复发,无继发性上尿路感染.结论 B超引导下局麻行PCNL简单、安全、有效,尤其适用于肾脏及输尿管上段结石患者,值得临床推广应用.

Objective To explore the feasibility and safety of methods of percutaneous nephrolithotomy （PCNL） under local anesthesia.Methods The clinical data of 89 patients treated by PCNL under local anesthesia and ultrasound from Mar.2008 to Oct.2012 were analyzed retrospectively,including 16 cases of complex kidney stones,renal pelvis calculi in 52 cases,18 cases of upper ureteral calculi.Infiltration anesthesia were carried by 1% lidocaine 10-40 ml from puncture point skin to renal capsule.Then PCNL under guidance of B ultrasound was performed.Results Eighty-six cases were successful punctured and operated on one stage PCNL.No damages were found in liver,spleen,pleural cavity and intestine during the operation.The free rate of renal pelvis calculi was 96.2% （50/52）,upper ureteral calculi was 100% （18/18）,complex renal calculi was 81.3 % （13/16）.All patients were followed up for 3-12 months（averaged 8.5 months）.The residual and recurrent stones were not found during the follow-up period,no secondary infection of upper urinary tract.Conclusions PCNL under guidance of ultrasound and local infiltration anesthesia is simple,safe,effective method,especially suitable for upper ureteral calculi patients,it is worthy of clinical application.