Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China.
Urology. 2013 Nov;82(5):1020-5. doi: 10.1016/j.urology.2013.07.007. Epub 2013 Aug 28.
To determine the feasibility and safety of percutaneous nephrolithotomy (PCNL) in treating upper urinary calculi under local infiltration anesthesia.
A series of 2000 patients with upper urinary calculi underwent PCNL under local infiltration anesthesia. Of the 2000 patients, 536 had upper ureteral calculi, 805 patients had pelvic calculi, and 659 patients had complex renal calculi. Pethidine premedication (75-100 mg) and Phenergan (25 mg) were used half an hour preoperatively. The mean pain scores at 0, 6, 24, and 48 hours postoperatively, the demographic characteristics, and the stones characteristics were evaluated to determine the feasibility. The complications were evaluated to determine the safety, and stone-free rate was evaluated to determine effectivity.
The mean American Society of Anesthesiologists score was 1.55 ± 0.54 (range, 1-3). The mean operative time was 48 minutes (range, 20-125). The mean Visual Analogue Scale scores at 0, 6, 24, and 48 hours postoperatively were 3.62, 3.02, 2.27, and 2.09, respectively. The mean hemoglobin drop was 1.06 g/dL (range, 0.2-6.8). Sixty-five patients (3.3%) received transfusions, 10 patients (0.5%) required selective renal angioembolism (Clavien grade II), and 1 patient (0.05%) received chest drainage therapy (Clavien grade II). The total stone-free rate was 85.8%.
Local infiltration anesthesia is a well-tolerated alternative anesthesia technique that provides effective intraoperative and postoperative analgesia for PCNL. PCNL performed under local infiltration anesthesia in a selected group of patients is feasible and provides satisfactory clinical outcomes. Comparative studies should be performed to classify efficacy, safety, tract quantity, dilation method, and the best candidates.
探讨局部浸润麻醉下经皮肾镜取石术（PCNL）治疗上尿路结石的可行性和安全性。
对 2000 例上尿路结石患者行 PCNL 治疗，其中输尿管上段结石 536 例，肾盂结石 805 例，复杂性肾结石 659 例。术前半小时给予哌替啶（75-100mg）和苯海拉明（25mg）进行预给药。评估术后 0、6、24、48 小时的平均疼痛评分、人口统计学特征和结石特征，以确定可行性。评估并发症以确定安全性，并评估结石清除率以确定有效性。
美国麻醉医师协会（ASA）评分平均为 1.55±0.54（范围 1-3）。手术时间平均为 48 分钟（范围 20-125 分钟）。术后 0、6、24、48 小时的平均视觉模拟评分（VAS）分别为 3.62、3.02、2.27、2.09。平均血红蛋白下降 1.06g/dL（范围 0.2-6.8g/dL）。65 例（3.3%）患者输血，10 例（0.5%）患者选择性肾动脉栓塞（Clavien Ⅱ级），1 例（0.05%）患者行胸腔引流治疗（Clavien Ⅱ级）。总结石清除率为 85.8%。
局部浸润麻醉是一种耐受良好的替代麻醉技术，可为 PCNL 提供有效的术中及术后镇痛。在选择的患者群体中，局部浸润麻醉下进行 PCNL 是可行的，可获得满意的临床效果。应开展对照研究以对疗效、安全性、通道数量、扩张方法和最佳适应证进行分类。
