Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, P.R. China.
J Endourol. 2020 Nov;34(11):1121-1128. doi: 10.1089/end.2020.0188. Epub 2020 Aug 4.
To determine the effectiveness and safety of retrograde intrarenal surgery (RIRS) under regional anesthesia (RA) general anesthesia (GA). In February 2020, a comprehensive search of PubMed, EMBASE, Web of Science, Cochrane Library, ClinicalTrials.gov, and WHO International Clinical Trials Registry was performed to find eligible studies comparing outcomes of GA and RA during RIRS procedure. Result parameters, including stone-free rate (SFR), operation time, postoperative length of stay, postoperative first-day visual analog scale (VAS) score, and complication rates were assessed using RevMan 5.3. Six studies (five randomized controlled trials and one retrospective study) with 1747 individuals were included. Pooled results revealed no statistical difference exist concerning SFR (odds ratio [OR] = 1.07, = 0.63), postoperative length of stay (weighted mean difference [MD] = 0.08, = 0.54), postoperative first-day VAS score (MD = -0.10, = 0.23), and complication rates (OR = 0.91, = 0.46). However, the RA group had shorter operation time (MD = -5.41, < 0.00001) compared with GA group. The present study showed that RA demonstrated shorter operation time than GA, and was similar to GA regarding SFR, postoperative length of stay, postoperative first-day VAS score, and complication rates. We considered that RA might be a better alternative with prudent patient selection.
比较全身麻醉（GA）和区域麻醉（RA）下经皮肾镜取石术（RIRS）的有效性和安全性。2020 年 2 月，我们全面检索了 PubMed、EMBASE、Web of Science、Cochrane 图书馆、ClinicalTrials.gov 和世卫组织国际临床试验注册平台，以查找比较 GA 和 RA 用于 RIRS 手术时结局的合格研究。使用 RevMan 5.3 评估结果参数，包括无石率（SFR）、手术时间、术后住院时间、术后第 1 天视觉模拟评分（VAS）和并发症发生率。纳入了 6 项研究（5 项随机对照试验和 1 项回顾性研究）共 1747 人。汇总结果表明，SFR 方面无统计学差异（比值比[OR] = 1.07， = 0.63）、术后住院时间（加权均数差[MD] = 0.08， = 0.54）、术后第 1 天 VAS 评分（MD = -0.10， = 0.23）和并发症发生率（OR = 0.91， = 0.46）。然而，RA 组的手术时间比 GA 组短（MD = -5.41， < 0.00001）。本研究表明，与 GA 相比，RA 具有更短的手术时间，并且在 SFR、术后住院时间、术后第 1 天 VAS 评分和并发症发生率方面与 GA 相似。我们认为，RA 可能是一种更好的选择，但需要谨慎选择患者。
