局麻输尿管软镜碎石术治疗上尿路结石疗效及围手术期疼痛的危险因素

Clinical efficacy of flexible ureteroscopic lithotripsy under local anesthesia and risk factors of perioperative pain

目的探讨局部麻醉(LA)下输尿管软镜碎石术(FURL)治疗上尿路结石的疗效,分析其手术相关疼痛的危险因素。方法回顾性分析2022年4月—2022年9月于重庆医科大学附属第一医院泌尿外科采用FURL治疗的255例患者的基本资料及手术相关资料,收集患者输尿管镜检、置软镜鞘、钬激光碎石及术后1、8 h的疼痛视觉模拟(VAS)评分情况,比较明显疼痛组(VAS≥5分)和无明显疼痛组(VAS<5分)的临床及随访资料,通过logistic回归分析患者LA下FURL疼痛的影响因素。结果最终198(77.6%)例患者顺利完成手术,结石清除率(SFR)为89.9%(178/198)。输尿管镜检时VAS评分较其他阶段更高,为(4.49±1.08)分,73例(28.6%)出现明显疼痛。单因素分析显示明显疼痛与性别、既往手术史、年龄、体质量指数(BMI)、文化程度、美国麻醉医师协会(ASA)分级均存在关联(P<0.05)。多因素分析发现男性(OR=2.896,95%CI:1.413~5.933,P=0.040)、BMI≥28(OR=7.776,95%CI:2.268~26.657,P=0.001)是LA下FURL明显疼痛的独立危险因素;年龄≥65岁(OR=0.237,95%CI:0.083~0.672,P=0.007)、既往有手术史(OR=0.156,95%CI:0.032~0.754,P=0.021)是出现明显疼痛的保护因素。结论LA下FURL治疗上尿路结石可行、有效。术中出现明显疼痛与性别、BMI、年龄、既往手术史等因素有关。

Objective To explore the efficacy of flexible ureteroscopic lithotripsy(FURL)under local anesthesia(LA)in the treatment of upper urinary tract calculi,and to analyze the risk factors of pain.Methods Clinical data of 255 patients treated during Apr.2022 and Sep.2022 were reviewed,including visual analogue score(VAS)of pain during ureteroscopy,sheath placement,holmium laser lithotripsy,1 hour and 8 hours after operation.VAS≥5 was defined as significant pain.Clinical and follow-up data of the significant pain group and non-significant pain group were analyzed with logistic regression to analyze the risk factors of pain in FURL under LA.Results Altogether 198 patients(77.6%)successfully completed the operation,and the stone-free rate(SFR)was 89.9%(178/198).The VAS of ureteroscopy was the highest(4.49±1.08),and 73 patients(28.6%)experienced significant pain.Univariate analysis showed that significant pain was associated with gender,previous surgical history,age,body mass index(BMI),education level,and ASA classification(P<0.05).Multivariate analysis showed that male(OR=2.896,95%CI:1.413-5.933,P=0.040)and BMI≥28(OR=7.776,95%CI:2.268-26.657,P=0.001)were independent risk factors of significant pain,while age≥65 years(OR=0.237,95%CI:0.083-0.672,P=0.007)and previous surgical history(OR=0.156,95%CI:0.032-0.754,P=0.021)were the protective factors.Conclusion It is feasible and effective to treat upper urinary tract calculi with FURL under LA.The presence of significant pain is associated with factors such as gender,age,BMI and previous surgical history.