局麻下双镜联合碎石取石术治疗高危复杂性肾结石14例疗效分析

Efficacy of Percutaneous Nephrolithotomy Combined With Flexible Ureteroscopic Lithotripsy Under Local Anesthesia for 14 Complex Kidney Calculi Patients With High Risk Factors

目的探讨局麻下双镜联合碎石取石术治疗高危复杂性肾结石的可行性及安全性。方法2018年9月~2021年8月我科对14例合并多种高危因素的复杂肾结石在局麻下行经皮肾镜联合输尿管软镜碎石取石术。采用视觉模拟评分(Visual Analogue Scale,VAS)评估术中、术后疼痛程度,术后采用Clavien-Dindo分级系统评估并发症发生情况,术后4周复查泌尿系CT评估结石一期清除率。结果14例均在局麻下成功完成双镜联合碎石取石术,手术成功率100%。手术时间50~165 min,中位手术时间105 min。术中经皮肾通道建立、输尿管镜检查、输尿管软镜鞘置入、碎石过程和术后2、6、24 h疼痛VAS评分分别为(3.9±0.8)、(3.3±0.5)、(2.4±0.5)、(2.9±0.5)、(2.6±0.6)、(2.1±0.3)和(1.4±0.5)分,14例均对术中镇痛效果满意,术中无一例因无法耐受手术而更改麻醉方式。术后1例需要输血。1例术后发热>38.5℃,予以敏感抗生素治疗后好转。围术期无Clavien-DindoⅡ级以上并发症。术后住院时间4~10 d,平均5.9 d。术后4周复查泌尿系CT,一期结石清除率78.6%(11/14),其中3例残石最长径>4 mm,2~4周后局麻下行输尿管软镜清石。结论局麻下双镜联合碎石取石术处理高危复杂性肾结石安全、可行。

Objective To investigate the feasibility and safety of percutaneous nephrolithotomy combined with flexible ureteroscopic lithotripsy under local anesthesia for complex kidney calculi patients with high risk factors.Methods A total of 14 complex kidney calculi patients with high risk factors from August 2018 to August 2021 were enrolled and analyzed retrospectively.All the patients underwent percutaneous nephrolithotomy combined with flexible ureteroscopic lithotripsy under local anesthesia.The visual analogue scale(VAS)was used to evaluate intraoperative and postoperative pain levels.The Clavien-Dindo grading system was used to assess postoperative complications.The CT re-examination was completed 4 weeks after surgery to assess the first-stage stone-free rate(SFR).Results All the patients successfully underwent percutaneous nephrolithotomy combined with ureteroscopic lithotripsy under local anesthesia.The success rate of the operation was 100%,and the operation time was 50-165 min,with a median of 105 min.The mean intraoperative percutaneous renal access establishment,ureteroscopy,ureteral flexible sheath placement,lithotripsy procedure and 2 h,6 h and 24 h postoperative VAS scores were(3.9±0.8),(3.3±0.5),(2.4±0.5),(2.9±0.5),(2.6±0.6),(2.1±0.3)and(1.4±0.5)points,respectively.All the patients were satisfied with the intraoperative analgesia.No patients changed their anesthesia method intraoperatively because they could not tolerate the procedure.One patient required postoperative blood transfusion.One patient had a postoperative fever>38.5℃,which resolved after treatment with sensitive antibiotics.There were no Clavien-DindoⅡor higher complications during the perioperative period.The postoperative hospital stay was 4-10 d,with a mean of 5.9 d.The CT was reviewed 4 weeks after surgery,and the first-stage SFR was 78.6%(11/14).Three patients had residual stones>4 mm,and the stones were cleared by flexible ureteroscopic under local anesthesia 2-4 weeks later.Conclusion Percutaneous nephrolithotomy combined with flexible ureteroscopic under local anesthesia is a safe and feasible treatment for complex kidney calculi patients with high risk factors.