局麻加强化麻醉下微创经皮肾镜取石术治疗上尿路结石

目的探讨局麻加强化麻醉下微创经皮肾镜取石术（minimally invasive percutaneous nephrolithotomy,MPCNL）治疗上尿路结石的可行性和有效性。方法 2007年9月～2009年12月,选择位于L3水平以上的输尿管结石〉0.8 cm,单发肾盂、肾盏肾结石≤2.5 cm,共56例。单发肾盂、肾盏结石23例,输尿管上段结石18例,输尿管上段结石合并单发肾盂、肾盏结石15例。术前10 min肌注盐酸哌替啶50～100 mg,术中1%盐酸利多卡因局部浸润麻醉。采用X线引导建立通道行MPCNL。结果术中麻醉效果均满意。56例69侧上尿路结石均为单通道取石,平均手术时间67 min（38～91 min）。一期手术结石取净率92.8%（64/69）,二期手术取石5侧,1侧肾内残留少量小结石,结石总清除率98.6%（68/69）。平均住院时间7.4 d（4～11 d）。无胸腹腔损伤、肠穿孔等周围脏器损伤。51例随访3～6个月,未见结石残留复发。结论选择合适病例,局麻加强化麻醉下MPCNL治疗上尿路结石是一种可行、有效的方法。

Minimally Invasive Percutaneous Nephrolithotomy under Potentiated Local Anesthesia for Upper Urinary Calculi

Objective To assess the feasibility and superiority of minimally invasive percutaneous nephrolithotomy（MPCNL） in treating upper urinary calculi under potentiated local anesthesia. Methods We retrospectively investigated 56 patients suffering from single pelvicalyceal calculi（stone size ≤ 2.5 cm） or proximal ureteral calculi that was higher than the level of the third lumbar vertebra（stone size 0.8 cm）.The patients received X-ray-guided MPCNL under local anesthesia（1% lidocaine hydrochloridum） and potentiated anesthesia（50-100 mg of intramuscular pethidini hydrochloridum） in our hospital from September 2007 to December 2009.Of the 56 cases,single pelvicalyceal calculi were detected in 23 cases,upper ureteral calculi in 18 cases,and upper ureteral calculi complicated with single pelvicalyceal calculi in 15. Results The whole anesthesia process during the operations was satisfying.All the 56 cases（69 sides） underwent MPCNL via a single tract with a mean operation time of 67 minutes（38-91 min）.The stone-free rate was 92.8%（64/69） on one session.A second surgery for stone removal was needed in 5 sides.In one side,a few residual renal stones were found after the second operation,but no third operation was performed.The final stone-free rate was 98.6%（68/69） in all of the cases.And the mean hospital stay was 7.4 days（4-11 days）.No chest or abdominal injuries,intestinal perforation,or injuries to the surrounding organs were detected.The patients were followed up for 3-6 months,during which no residual stones or recurrence was found. Conclusion MPCNL is feasible and effective for upper urinary calculi under potentiated local anesthesia for selected cases.