局麻下微通道经皮肾镜取石术治疗上尿路结石83例临床分析

Micro-channel percutaneous nephrolithotomy in treatment of 83 cases of upper urinary calculi under local anesthesia: a clinical analysis

目的:探讨局麻下微通道经皮肾镜取石术(PCNL)治疗上尿路结石的临床疗效。方法:回顾性分析2016年12至2018年1月南昌县人民医院泌尿外科收治的肾、输尿管上段结石患者83例的临床资料,所有患者均于局麻下行微通道PCNL。记录患者手术情况、术中视觉模拟评分(VAS)、住院时间、术后并发症发生情况。结果:所有患者均一次性穿刺成功,除2例肾积脓患者放置肾造瘘管外均行一期取石术。手术时间30~180 min。术中VAS评分1~6分,平均(4.2±1.1)分。术中无一例因疼痛而终止手术或变更麻醉方式。住院时间6~28 d,平均(8.8±3.2) d。所有患者未发生严重穿刺并发症。结论:局麻下微通道PCNL具有手术操作难度低、低风险、低并发症、高效费比的优点,值得临床推广应用。

Objective: To investigate the clinical effect of micro-channel percutaneous nephrolithotomy( PCNL) in the treatment of upper urinary calculi under local anesthesia. Methods: The clinical data of 83 patients with kidney and upper urinary calculi,who stayed in the Department of Urology,Nanchang County People’s Hospital between January 2016 and January 2018,were retrospectively analyzed. All patients underwent micro-channel PCNL under local anesthesia. The surgical situation,intraoperative visual analogue scale( VAS),length of hospital stay,and postoperative complications were recorded. Results: All patients were successfully treated with one-time puncture and primary lithotripsy except for two patients with renal abscess underwent nephrostomy. The operation time was 30-180 min. The intraoperative VAS score was 1-6 points with an average of4.2±1.1 points. There were no cases of terminated surgery or changed anesthesia due to pain intolerance during the operation. The length of hospital stay was 6-28 d with an average of 8.8± 3.2 d. No severe complications of puncture occurred in all patients. Conclusion: The micro-channel PCNL under local anesthesia shows the advantages of low operation difficulty,risks and complications,and high cost-effectiveness,which justifies widespread use in clinical settings.