局麻下经尿道膀胱结石碎石取石术治疗麻醉高风险患者的疗效

doi:10.3877/cma.j.issn.1674-3253.2026.01.007

目的

探讨局部麻醉下经尿道膀胱结石碎石取石术处理高麻醉风险患者膀胱结石的效果。

方法

收集2021年9月至2024年5月南京鼓楼医院泌尿外科收治的30例局部麻醉下行经尿道膀胱结石碎石取石术患者的临床资料，分析患者的基线数据（年龄、性别、麻醉分级、结石数目、结石大小、合并疾病）和围手术期资料（手术时间、出血量、术后住院天数、术后并发症）。通过统计患者局麻手术中不同时期的视觉模拟疼痛（VAS）评分及手术清石率（SFR）来评价手术效果。

结果

顺利完成30例一期局部麻醉经尿道膀胱结石碎石取石术，其中男性患者29例，女性1例。平均手术时间（69.00±24.73）min，平均手术出血（4.00±3.21）ml，平均术后住院天数（2.41±1.40）d。患者VAS评分各阶段分别为输尿管镜检（1.73±0.64）分，钬激光/气压弹道碎石（3.43±0.77）分，置入外鞘（2.33±0.84）分，术后1 h（1.80±0.76）分，术后8 h（1.33±0.71）分。术中碎石时患者疼痛评分最高，置入外鞘时次之。术后并发症包括肉眼血尿5例，恶心呕吐3例，发热2例，无感染性休克等严重并发症。一期SFR为93.33%（28/30）。

结论

局麻下经尿道膀胱结石碎石取石术经术前严格评估和充分准备后可尝试用于术前麻醉高风险的患者。

关键词: 膀胱结石, 经尿道碎石取石术, 局部麻醉, 麻醉高风险

Objective

To explore the effectiveness of transurethral lithotomy of bladder calculus in high-risk anesthesia patients under local anesthesia (LA).

Methods

The clinical data of 30 bladder calculus patients underwent transurethral lithotomy using ureteroscope under LA in the Department of Urology, Nanjing Drum Tower Hospital from September 2021 to May 2024 were collected. The general clinical data (age, gender, ASA grade, stone number, stone size, comorbidity) and postoperative clinical data (surgical time, blood loss, postoperative hospital stay, postoperative complications) were analyzed. The surgical effects were evaluated by analysing the Visual Analogue Scale (VAS) scores at various stages of the procedure during local anesthesia, as well as the stone-free rate (SFR).

Results

30 cases of primary transurethral lithotomy of bladder calculus under LA were completed, including 29 males and 1 female. The operation time was (69.00±24.73) minutes, the blood loss was (4.00±3.21) ml, and the postoperative hospital stay was (2.41±1.40) days. At each stage of procedure, the VAS was (1.73±0.64) for ureteroscopy, (3.43±0.77) for holmium laser/pneumatic ballistics lithotripsy, (2.33±0.84) for placement of sheath, (1.80±0.76) at 1 h after operation and (1.33±0.71) at 8 h after operation. The lithotripsy had the highest score of pain, and the placement of sheath followed. Postoperative complications included 5 cases of gross hematuria, 3 cases of nausea and vomiting, and 2 cases of fever. None serious complications like septic shock were observed. The SFR of patients was 93.33%(28/30).

Conclusion

After strict preoperative assessment and adequate preparation, transurethral lithotomy of bladder calculus can be attempted for patients with high-risk anesthesia.

Key words: Bladder calculus, Transurethral lithotomy, Local anesthesia, High-risk anesthesia

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Clinical effect of transurethral lithotomy of bladder calculus in high-risk anesthesia patients under local anesthesia

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Clinical effect of transurethral lithotomy of bladder calculus in high-risk anesthesia patients under local anesthesia