Department of Surgery, Clemenceau Medical Center, Dubai, United Arab Emirates.
Department of Surgery, King Hussein Cancer Center, Amman, Jordan.
J Endourol. 2023 Aug;37(8):855-862. doi: 10.1089/end.2023.0184. Epub 2023 Jul 5.
Several studies have reported on the safety and feasibility of percutaneous nephrolithotomy (PCNL) under local anesthesia (LA). The aim of this systematic review is to assess the perioperative outcomes of PCNL under LA. Three electronic databases, including MEDLINE, EMBASE, and Web of Science, were searched for relevant English-language studies published from January 1980 to March 2023. The systematic review has been performed according to the Cochrane style and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. The primary outcomes include stone-free rate (SFR) and conversion to general anesthesia (GA). Secondary outcomes include postoperative complications. Of 301 articles that were extracted, 42 full-text articles were selected, of which 36 were excluded, yielding a total of 6 articles in our results. A total of 3646 patients were included in this review. The SFR of PCNL under LA ranged between 69.9% and 93.3%. PCNL under LA was not tolerated by 19 (0.5%) patients: 6 patients had conversion to general anesthesia, 2 had conversion to epidural anesthesia, and 11 had their procedure terminated. The overall complication rates varied from 4.8% to 21% across studies. Grade I-II complications were reported in 2.4%-16.7% of cases, while grade III-IV complications were encountered in 0.5%-5% of patients. In this review, we found a few studies that examined the outcomes of PCNL under LA, which highlight the feasibility and safety of PCNL under LA and the low conversion rate to GA.
几项研究报告了在局部麻醉（LA）下进行经皮肾镜取石术（PCNL）的安全性和可行性。本系统评价旨在评估 LA 下 PCNL 的围手术期结果。 我们检索了三个电子数据库，包括 MEDLINE、EMBASE 和 Web of Science，以获取从 1980 年 1 月至 2023 年 3 月发表的相关英文研究。系统评价按照 Cochrane 风格和系统评价和荟萃分析的首选报告项目进行。主要结果包括无结石率（SFR）和转为全身麻醉（GA）。次要结果包括术后并发症。 在提取的 301 篇文章中，有 42 篇全文文章被选中，其中 36 篇被排除，最终有 6 篇文章纳入我们的结果。本综述共纳入 3646 名患者。LA 下 PCNL 的 SFR 范围为 69.9%至 93.3%。LA 下 PCNL 有 19 名（0.5%）患者无法耐受：6 名患者转为全身麻醉，2 名患者转为硬膜外麻醉，11 名患者终止手术。总体并发症发生率在不同研究中从 4.8%到 21%不等。2.4%-16.7%的病例报告了 I-II 级并发症，而 0.5%-5%的患者发生了 III-IV 级并发症。 在本综述中，我们发现了一些研究检查了 LA 下 PCNL 的结果，这些研究强调了 LA 下 PCNL 的可行性和安全性，以及转为 GA 的低转化率。
