基于加速康复外科（ERAS）理念的局部麻醉下经皮肾镜取石术（PCNL）疗效的前瞻性研究。

Prospective study of the efficacy of PCNL under local anesthesia based on the ERAS concept.

作者信息

Liu Zhaorong, Yang Longfei, Huang Jianbiao, Zhang Dingyi, Li Yugen, Wang Xiaoning, Luo Fengzhen, He Zhihua

机构信息

Department of Urology, Yudu County People's Hospital, Yudu, Jiangxi, China.

Department of Urology, The First Affiliated Hospital, Gannan Medical University, Ganzhou, Jiangxi, China.

出版信息

Front Surg. 2025 May 9;12:1595466. doi: 10.3389/fsurg.2025.1595466. eCollection 2025.

DOI:10.3389/fsurg.2025.1595466

PMID:40416723

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12098362/

Abstract

OBJECTIVE

To evaluate the feasibility, safety, and efficacy of local anesthesia applied to percutaneous nephrolithotomy (PCNL) under Enhanced Recovery After Surgery (ERAS) for treating upper urinary tract stones.

MATERIALS AND METHODS

This study was a prospective, single-center randomized controlled study in which the patients were randomly divided into two groups: 40 in the ERAS PCNL under local anesthesia (ERAS-LA) group and 40 in the ERAS PCNL under general anesthesia (ERAS-GA) group). The primary indicators were stone-free rate; the secondary outcomes were intraoperative and postoperative complications, intraoperative and postoperative VAS pain scores and postoperative stress response indicators. A meta-analysis was also performed using RevMan 5.4 software by searching relevant literatures in PubMed/Medline, Web of Science and Embase.

RESULTS

The stone clearance rates at 48 h were similar between the two groups [ERAS-LA: 85.0% (34/40) vs. ERAS-GA: 87.5% (35/40), = 0.800] and both 90% at 1 month. The incidence of surgical complications was similar between the two group. The intraoperative pain score in ERAS-LA group was 2.90 ± 0.74, and the postoperative 24-h pain score was comparable between the two groups (ERAS-LA: 2.65 ± 1.35 vs. ERAS-GA: 2.63 ± 0.98, = 0.925), with good pain control. The mean total operative time was lower in ERAS-LA group than in ERAS-GA group (68.15 ± 24.11 min vs. 82.125 ± 20.42 min, = 0.006). Postoperative hemoglobin change values (3.38 ± 3.00 × 10/L vs. 5.22 ± 4.18 × 10/L, = 0.027) and stress response factors including C-reactive protein (8.39 ± 7.46 mg/L vs. 10.47 ± 10.30 mg/L, = 0.035) and interleukin-6 (5.40 ± 1.50 pg/ml vs. 10.57 ± 1.82 pg/ml, = 0.041) were significantly lower in ERAS-LA group. The mean catheter retention, fistula retention, and postoperative hospital stay were all significantly lower in ERSA-LA group than in ERSA-GA group (2.3%, 2.9%, and 5.08 days vs. 3.33%, 4.38%, and 6.35 days, < 0.05). The results of the meta-analysis were similar to that of our study.

CONCLUSIONS

Local anesthesia applied to ERAS-managed PCNL have a comparable stone clearance rates and complication rates, and a faster postoperative recovery, lower surgical stress, length of stay, anesthesia costs and hospital costs than general anesthesia.

CLINICAL TRIAL REGISTRATION

http://www.medresman.org.cn, identifier (ChiCTR2100045681).

摘要

目的

评估局部麻醉应用于外科快速康复（ERAS）理念下的经皮肾镜取石术（PCNL）治疗上尿路结石的可行性、安全性及有效性。

材料与方法

本研究为前瞻性、单中心随机对照研究，将患者随机分为两组：局部麻醉下ERAS-PCNL组（ERAS-LA组）40例和全身麻醉下ERAS-PCNL组（ERAS-GA组）40例。主要指标为结石清除率；次要结局为术中及术后并发症、术中及术后视觉模拟评分法（VAS）疼痛评分以及术后应激反应指标。还通过在PubMed/Medline、Web of Science和Embase中检索相关文献，使用RevMan 5.4软件进行荟萃分析。

结果

两组48小时结石清除率相似[ERAS-LA组：85.0%（34/40） vs. ERAS-GA组：87.5%（35/40），P = 0.800]，1个月时均为90%。两组手术并发症发生率相似。ERAS-LA组术中疼痛评分为2.90±0.74，两组术后24小时疼痛评分相当（ERAS-LA组：2.65±1.35 vs. ERAS-GA组：2.63±0.98，P = 0.925），疼痛控制良好。ERAS-LA组平均总手术时间低于ERAS-GA组（68.15±24.11分钟 vs. 82.125±20.42分钟，P = 0.006）。ERAS-LA组术后血红蛋白变化值（3.38±3.00×10/L vs. 5.22±4.18×10/L，P = 0.027）以及包括C反应蛋白（8.39±7.46mg/L vs. 10.47±10.30mg/L，P = 0.035）和白细胞介素-6（5.40±1.50pg/ml vs. 10.57±1.82pg/ml，P = 0.041）在内的应激反应因子均显著更低。ERSA-LA组平均导尿管留置时间、瘘管留置时间及术后住院时间均显著低于ERSA-GA组（2.3%、2.9%和5.08天 vs. 3.33%、4.38%和6.35天，P < 0.05）。荟萃分析结果与本研究相似。