局麻输尿管软镜钬激光碎石取石术治疗高危上尿路结石患者疗效观察

Clinical effect of flexible ureteroscopy in the treatment of upper urinary calculi in high risk patients under local anesthesia

目的分析局部麻醉下行输尿管软镜钬激光碎石取石术(FURS)处理高危患者上尿路结石的有效性、安全性并总结相关实践经验。方法收集2020年9月—2022年2月重庆医科大学附属第一医院泌尿外科收治的109例局部麻醉下行FURS患者的临床资料,记录及分析局麻软镜碎石手术患者的基线资料(性别、年龄、BMI、结石情况、结石大小、ASA分级、合并疾病)和围手术期资料(手术时长、术中出血量、术前等待时间、术后住院天数、术后并发症)。记录局麻手术患者围手术期不同节点的视觉模拟疼痛评分(VAS)及手术清石率(SFR)。结果81例(74.3%)患者顺利完成FURS,28例(25.7%)患者因术中难以耐受疼痛行输尿管支架管置入,其中男21例,女7例。平均手术时间(59.00±17.37)min;平均术中出血量(2.72±0.16)mL;平均患者术前等待时间(2.58±0.15)d;平均术后住院天数(1.07±0.52)d。患者围手术期各阶段VAS评分分别为输尿管镜检(4.43±2.01)分、置软镜鞘(3.37±1.33)分、碎石(2.45±0.78)分、术后1 h(2.28±0.69)分、术后8 h(1.66±0.59)分。术中行输尿管镜检及输尿管扩张时疼痛评分最高,而置入输尿管软镜鞘时次之。术后并发症包括:恶心呕吐30例,肉眼血尿21例,发热10例,肾绞痛3例。未出现如输尿管撕脱或者断裂、脓毒症等严重并发症。本组研究对象SFR为88.9%(72/81)。结论对于具有全麻禁忌证的上尿路结石高危患者,局部麻醉下行FURS是一种可行、安全、经济的手术方式。

Objective To assess the efficacy and safety and to summarize the practical experience of flexible ureteroscopy(FURS)in the treatment of upper urinary calculi in high-risk patients under local anesthesia(LA).Methods We collected the clinical data of 109 patients treated with FURS under LA in the Department of Urology,First Affiliated Hospital of Chongqing Medical University from September 2020 to February 2022.General clinical data(gender,age,body mass index,stone status,stone diameter,ASA grade,comorbidity)and perioperative clinical data(surgical time,blood loss,preoperative waiting time,postoperative hospital stay,postoperative complications)were recorded and analyzed.Visual analog scale(VAS)pain scores at different nodes in the perioperative period of patients undergoing LA surgery and stone free rate(SFR)were observed.Results Eighty-one(74.3%)patients were successfully completed the operation,but 28(25.7%)patients underwent ureteral stent implantation due to intraoperative intolerance of pain,including 21 males and 7 females.The average operation time was(59.00±17.37)minutes,and the average intraoperative blood loss was(2.72±0.16)mL.The average preoperative waiting time was(2.58±0.15)days,and the average postoperative hospital stay was(1.07±0.52)days.The VAS scores at each stage of the perioperative period were(4.43±2.01)for ureteroscopy,(3.37±1.33)for ureteral access sheath placement,(2.45±0.78)for lithotripsy,(2.28±0.69)at 1 hour after operation,and(1.66±0.59)at 8 hours after operation.Intraoperative ureteroscopy and ureteral dilatation had the highest pain score,followed by flexible ureteroscope sheath placement.Postoperative complications included nausea and vomiting in 30 cases,gross hematuria in 21 cases,fever in 10 cases,and renal colic in 3 cases.There were no serious complications such as ureteral avulsion,rupture or sepsis.SFR in our study was 88.9%(72/81).Conclusion For some patients with upper urinary calculi who have general anesthesia contraindications,FURS under LA is a feasible,safe and economical surgical method.