在日常实践中，脊柱麻醉是否是治疗结石病逆行性肾内手术的安全替代方法？
Is spinal anesthesia a safe alternative for retrograde intrarenal surgery for stone disease in daily practice?
机构信息
Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy.
Anesthesia and Transplant Surgical Intensive Care Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy.
出版信息
Arch Esp Urol. 2022 May 28;75(4):361-367. doi: 10.37554/en-j.arch.esp.urol-20210525-3501-21.
OBJECTIVES
Retrograde intrarenal surgery (RIRS) is commonly performed under general anesthesia (GA) because renal mobility during breathing may affect lithotripsy. However, spinal anesthesia (SA) is adopted in clinical practice due to clinical conditions that contraindicate GA. We aimed to compare results of RIRS for stones performed under GA compared to SA regarding stone-free rate (SFR) status and postoperative complications in a consecutive single-center series.
METHODS
We retrospectively reviewed all patients who underwent RIRS for stones between 2017 and 2020.
INCLUSION CRITERIA
age ≥ 18 years, renal stone burden deemed suitable for RIRS with a stone diameter ≤ 20 mm.
EXCLUSION CRITERIA
stones >20 mm, urinary tract infection, bilateral surgery, second-look procedures, unmodifiable bleeding diathesis, <5mm asymptomatic lower calyx stones. SFR was defined as no residual fragment >3 mm at 6-12 weeks follow-up. The choice of anesthesia was a shared decision between anesthesiologists and patient preference.
RESULTS
230 patients were included in the analysis. Mean age was 57.50±13.73 years. 33% of stones were located in the pelvis. 28.7% of patients had multiple stones. Mean cumulative stone diameter was 16.60±6.54 mm. 63% of patients underwent RIRS under SA. There were no significant differences between the two groups in terms of preoperative characteristics, except for comor-bidity, significantly higher in the GA group. Mean time of operating room occupation was longer in the GA group (81.58±35.37 minutes) than in the SA group (72.85±25.91 minutes,p=0.033). Length of stay was shorter in the SA group (mean 2.2±1.66 days vs 3.46±5.88 in GA,p=0.019). Logistic regression showed that multiple stones in the collecting system were associated with residual fragments (HR 0.386, 95%CI 0.151-0.991,p=0.04). There were no statistically significant differences in overall and high-grade complications, and in SFR between SA (75.9%) and GA groups (70.6%,p=0.317).
CONCLUSION
SA does not affect SFR and postoperative complications in patients who underwent RIRS in daily practice.
目的
逆行肾盂内碎石术（RIRS）通常在全身麻醉（GA）下进行，因为呼吸时肾脏的移动可能会影响碎石效果。然而，在临床实践中，由于存在 GA 禁忌的临床情况，会采用脊髓麻醉（SA）。我们旨在比较 GA 与 SA 下进行 RIRS 治疗结石的结果，包括无结石率（SFR）状态和术后并发症，这是一项连续的单中心研究。
方法
我们回顾性分析了 2017 年至 2020 年间接受 RIRS 治疗结石的所有患者。
纳入标准
年龄≥18 岁，肾结石负荷适合 RIRS，结石直径≤20mm。
排除标准
结石＞20mm、尿路感染、双侧手术、二次手术、不可改变的出血倾向、无症状的下盏＜5mm 结石。SFR 定义为 6-12 周随访时无残余＞3mm 碎片。麻醉选择是麻醉师和患者共同决定的。
结果
230 例患者纳入分析。平均年龄为 57.50±13.73 岁。33%的结石位于肾盂。28.7%的患者有多发性结石。平均结石总直径为 16.60±6.54mm。63%的患者接受 SA 下 RIRS。两组患者在术前特征方面无显著差异，除合并症外，GA 组明显更高。GA 组的手术室占用时间（81.58±35.37 分钟）长于 SA 组（72.85±25.91 分钟，p=0.033）。SA 组的住院时间较短（平均 2.2±1.66 天 vs GA 组的 3.46±5.88 天，p=0.019）。Logistic 回归显示，集合系统中的多发性结石与残石有关（HR 0.386，95%CI 0.151-0.991，p=0.04）。SA 组（75.9%）和 GA 组（70.6%，p=0.317）之间的总体和高级别并发症发生率和 SFR 无统计学差异。
结论
在日常实践中，SA 不会影响 RIRS 患者的 SFR 和术后并发症。
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