切换至 "中华医学电子期刊资源库"
高级检索
中华腔镜泌尿外科杂志(电子版)

中华腔镜泌尿外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (03) : 235 -238. doi: 10.3877/cma.j.issn.1674-3253.2022.03.010

临床研究

局麻下部分无管化微创经皮肾镜的临床疗效
赵小峰1, 刘明1, 蒋元文1, 陆敬义1,†(), 苏斌杰1, 陈枭1   
  1. 1. 834000　新疆，克拉玛依市中心医院泌尿外科
  • 收稿日期:2021-03-01 出版日期:2022-06-01
  • 通信作者: 陆敬义
  • 基金资助:
    新疆维吾尔自治区区域协同创新专项项目(2018E01006); 新疆维吾尔自治区克拉玛依市中心医院院级2017年度青科科研计划项目(QK2017-7)

Analysis of clinical results of tubeless-minimally invasive percutaneous nephrolithotripsy with local anesthesia

Xiaofeng Zhao1, Ming Liu1, Yuanwen Jiang1, Jingyi Lu1,†(), Binjie Su1, Xiao Chen1   

  1. 1. Department of Urology, Karamay Central Hospital of Xinjiang, Xinjiang 834000, China
  • Received:2021-03-01 Published:2022-06-01
  • Corresponding author: Jingyi Lu
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

赵小峰, 刘明, 蒋元文, 陆敬义, 苏斌杰, 陈枭. 局麻下部分无管化微创经皮肾镜的临床疗效[J]. 中华腔镜泌尿外科杂志(电子版), 2022, 16(03): 235-238.

Xiaofeng Zhao, Ming Liu, Yuanwen Jiang, Jingyi Lu, Binjie Su, Xiao Chen. Analysis of clinical results of tubeless-minimally invasive percutaneous nephrolithotripsy with local anesthesia[J]. Chinese Journal of Endourology(Electronic Edition), 2022, 16(03): 235-238.

目的

比较局麻下部分无管化微创经皮肾镜碎石取石术（PCNL）与普通MPCNL的临床结果，探讨局麻无管化MPCNL的安全性和临床疗效。

方法

回顾性分析我院2019年1月至2019年11月行局麻PCNL患者，局麻无管化MPCNL组的患者68例，局麻普通MPCNL组患者67例。比较两组患者的一般资料。

结果

两组患者临床资料具有可比性，无管化组术后平均住院时间为3.15 d，有管化组为6.48 d（P<0.01）；术后6 h VAS评分无管化组为4 h，有管化组为6.24（P<0.01）；术后第l天VAS评分无管化组为2.50，有管化组为3.84（P<0.01）；两组患者在手术时间、穿刺位置、术后血红蛋白下降率、出院当天VAS评分、术后发热、结石清除率差异无统计学意义（P>0.05）。

结论

局麻下行PCNL术简单安全有效，值得临床推广运用。无管化MPCNL治疗肾结石可减轻患者术后疼痛不适，缩短住院时间。

关键词: 肾结石, 局麻, 无管化, 经皮肾镜
Objective

To compare the clinical results of partially tubeless minimally invasive nephrolithotripsy (PCNL) and common MPCNL under local anesthesia, and to explore the safety and clinical efficacy of tubeless MPCNL under local anesthesia.

Methods

From January 2019 to November 2019, 68 patients who underwent PCNL with local anesthesia and 68 patients who underwent MPCNL with local anesthesia and 67 patients who underwent MPCNL with local anesthesia were retrospectively analyzed. The general data of the patients in the two groups were compared.

Results

The clinical data of the two groups were comparable. The average postoperative hospital stay was 3.15 d and 6.48 d in the non-tubular group (P<0.01); the VAS score at 6 h after operation was 4 h and 6.24 h in the tubular group (P<0.01); the VAS score at 1 day after operation was 2.50 and 3.84 in the tubular group (P<0.01); there was no significant difference in the operation time, puncture site, postoperative hemoglobin decrease rate, VAS score on the day of discharge, postoperative fever and stone clearance rate between the two groups (P>0.05).

Conclusion

PCNL under local anesthesia is simple, safe and effective, which is worthy of clinical application. Uncanalized MPCNL for the treatment of renal calculi can reduce postoperative pain and discomfort and shorten hospital stay.

Key words: Kidney stones, Local anesthesia, Tubeless, MPCNL
表1 两组局麻下行PCNL患者的临床资料比较
组别 例数 年龄[岁，(±s)] 性别(例) BMI(kg/m2) 结石大小[mm2，(±s)] 结石位置(例) 肾盂积水宽度[mm，(±s)]
男 女 上盏 中盏 肾盂 下盏
无管化组 68 39±10 46 22 23.51±3.48 653±209 10 11 32 15 16.3±6.6
有管化组 67 38±80 41 26 22.99±3.16 649±233 9 13 29 16 15.4±6.0
统计值   t=0.623 χ2=0.613 t=0.901 t=0.239 χ2=1.315 t=0.813
P值   0.118 0.475 0.204 0.239 0.352 0.341
表2 两组局麻下行PCNL患者术中及术后指标比较
组别 手术时间[min，(±s)] 住院天数[d，(±s)] 穿刺位置(例) 血红蛋白下降[g/dL，(±s)] 术后VAS评分(±s) 镇痛药物使用(例) 发热(例)
第12肋下 第11肋间 术后6 h 术后第1天 出院当天
无管化组 70±15 3.15±1.42 38 30 1.87±0.94 4.07±1.79 2.50±1.76 0.91±0.84 2 4
有管化组 72±17 6.48±1.88 32 35 1.57±0.90 6.24±1.33 3.83±2.22 1.15±0.93 6 3
统计值 t=0.055 t=8.148 χ2=0.892 t=1.913 t=7.976 t=3.879 t=1.560 χ2=2.190 χ2=0.135
P值 0.055 0.004 0.391 0.479 0.035 0.034 0.211 0.165 0.713
[1]
Ziemba JB, Matlaga BR. Guideline of guidelines: kidney stones [J]. BJU Int, 2015, 116(2): 184-189.
[2]
Moosanejad N, Firouzian A, Hashemi SA, et al. Comparison of totally tubeless percutaneous nephrolithotomy and standard percutaneous nephrolithotomy for kidney stones: a randomized, clinical trial [J]. Braz J Med Biol Res, 2016, 49(4): 4878-4785.
[3]
Kirac M, Tepeler A, Bozkurt OF, et al. The efficacy of bupivacaine infiltration on the nephrostomy tract in tubeless and standard percutaneous nephrolithotomy: a prospective, randomized, multicenter study [J]. Urology, 2013, 82(3): 526-531.
[4]
Gonulalan U, Cicek T, Istanbulluoglu O, et al. Tubeless percutaneous nephrolithotomy is effective and safe in short- and long-term urinary drainage [J]. Urolithiasis, 2013, 41(4): 341-346.
[5]
Kuzgunbay B, Turunc T, Akin S, et al. Percutaneous nephrolithotomy under general versus combined spinal-epidural anesthesia [J]. J Endourol, 2009, 23(11): 1835-1838.
[6]
Singh V, Sinha RJ, Sankhwar SN, et al. A prospective randomized study comparing percutaneous nephrolithotomy under combined spinal-epidural anesthesia with percutaneous nephrolithotomy under general anesthesia [J]. Urol Int, 2011, 87(3): 293-298.
[7]
郭震华，那彦群. 实用泌尿外科学[M]. 北京:人民卫生出版社，2013: 188
[8]
Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery [J]. Lancet, 2003, 362(9399): 1921-1928.
[9]
Ecke TH, Barski D, Weingart G, et al. Presentation of a method at the Exploration Stage according to IDEAL: Percutaneous nephrolithotomy (PCNL) under local infiltrative anesthesia is a feasible and effective method - retrospective analysis of 439 patients [J]. Int J Med Sci, 2017, 14(4): 302-309.
[10]
丘捷文，黄小佳，文博, 等. 腰硬联合麻醉与局麻用于经皮肾镜取石术的比较 [J/CD]. 中华腔镜泌尿外科杂志（电子版）, 2015, 9(3): 33-35.
[11]
Giannakopoulos S, Giannopoulos S, Gardikis S, et al. Second-look flexible nephroscopy combined with holmium: yttrium-aluminum-garnet laser lithotripsy under local anesthesia: a prospective study [J]. Urology, 2017, 99(3) :27-32.
[12]
Tangpaitoon T, Nisoog C, Lojanapiwat B. Efficacy and safety of percutaneous nephrolithotomy (PCNL): a prospective and randomized study comparing regional epidural anesthesia with general anesthesia [J]. Int Braz J Urol, 2012, 38(4): 504-511.
[13]
Sourial MW, Francois N, Box GN, et al. Supracostal access tubeless percutaneous nephrolithotomy: minimizing complications [J]. World J Urol, 2019, 37(7):1429-1433.
[14]
Bellman GC, Davidoff R, Candela J, et al. Tubeless percutaneous renal surgery [J]. J Urol, 1997, 157(5): 1578-1582.
[15]
Tirtayasa PMW, Yuri P, Birowo P, et al. Safety of tubeless or totally tubeless drainage and nephrostomy tube as a drainage following percutaneous nephrolithotomy: A comprehensive review [J]. Asian J Surg, 2017, 40(6): 419-423.
[16]
Shen P, Liu Y, Wang J. Nephrostomy tube-free versus nephrostomy tube for renal drainage after percutaneous nephrolithotomy: a systematic review and meta-analysis [J]. Urol Int, 2012, 88(3): 298-306.
[17]
Zhong Q, Zheng C, Mo J, et al. Total tubeless versus standard percutaneous nephrolithotomy: a meta-analysis [J]. J Endourol, 2013, 27(4): 420-426.
[18]
Choi SW, Kim KS, Kim JH, et al. Totally tubeless versus standard percutaneous nephrolithotomy for renal stones: analysis of clinical outcomes and cost [J]. J Endourol, 2014, 28(12): 1487-1494.
[19]
Kokorovic A, Wilson JW, Beiko D. Outpatient bilateral supracostal tubeless percutaneous nephrolithotomy for staghorn calculi [J]. Can Urol Assoc J, 2014, 8(3-4): 273-275.
[1] 郑鹏, 吴赛萍, 谢秀璋, 史庆丰. 术前预测感染性肾结石列线图模型的构建及验证[J]. 中华实验和临床感染病杂志(电子版), 2023, 17(05): 299-306.
[2] 左解鹏, 周典晟, 王健, 刘文博, 吴长利, 田大伟. 局麻下利用软性膀胱镜联合铥激光治疗麻醉高风险膀胱肿瘤患者的经验[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 563-569.
[3] 陈美仁, 戴逸骅, 张茹, 戴英波. "蛙泳"俯卧位在经皮肾镜术中的应用[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 581-586.
[4] 龙卫兵, 刘晓冰, 易仁政, 邹德博, 蒋玉斌, 陈亮, 谢超群, 刘红叶, 粟周华, 张雄峰, 李麒麟. CT、B超预定位"三步法"经皮肾镜治疗上尿路结石[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 587-592.
[5] 张文涛, 陈俊明, 秦海生, 杨胜进, 余朝辉, 白冰, 王世洋, 段彩莲, 王震. 4.8 F可视肾镜在飞行人员肾脏小结石中的临床应用[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 593-596.
[6] 方钟进, 黄华生, 陈早庆, 郁兆存, 郑哲明, 谢永康, 陈仲宁, 邹演辉, 刘乾海, 陈镇宏. 负压组合式输尿管镜联合输尿管软镜与经皮肾镜治疗复杂性肾结石的比较[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 601-604.
[7] 曹智, 朱希望, 王尉, 张辉, 杨成林, 张小明. 经皮肾镜碎石取石术中不同肾盂内压力与围术期并发症相关性研究[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 616-620.
[8] 方道成, 胡媛媛. 钙和维生素D与肾结石形成关系的研究进展[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 653-656.
[9] 周川鹏, 杨浩, 魏微阳, 王奇, 黄亚强. 微创与标准通道经皮肾镜治疗肾结石合并肾功能不全的对比研究[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(05): 470-475.
[10] 徐哲, 罗杰, 吴强, 李忠, 王晓伟, 郑硕, 郝晓东, 王照. 腹主动脉钙化患者肾结石成分特点及危险因素分析[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(05): 481-485.
[11] 张磊, 米洋, 王昌喜, 李曜行, 王小东, 牛旭东, 王靖宇. 一次性输尿管软镜通路鞘两种置入深度的临床研究[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(05): 486-489,494.
[12] 张星宇, 李炯明, 刘建和, 方克伟, 王光, 杨博伟. 无管化PCNL适应证选择及疗效观察[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(05): 512-515.
[13] 颜廷帅, 全科立, 舒建平, 何高飞. 经皮肾镜碎石取石术中留置双J管制造肾积水的研究进展[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(04): 415-417.
[14] 张曦才, 曹先德. 经皮肾镜取石术治疗无积水肾结石中皮肾通道建立的应用研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 911-915.
[15] 张曦才, 曹先德, 高建萍, 沈大庆, 曹现祥, 郭诗杰, 李凤岳, 肖琳. 免人工肾积水在超声引导经皮肾镜取石术中的应用[J]. 中华临床医师杂志(电子版), 2023, 17(07): 798-803.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号