局麻下免逆行插管应用Y型负压吸引鞘行经皮肾镜术疗效分析

目的探讨局部麻醉免逆行插管下运用Y型负压吸引鞘行经皮肾镜碎石取石术（PCNL）的效果。 方法通过倾向性评分匹配肾门或第三腰椎横突以上输尿管单颗或简单多颗结石120例，分为观察组60例和对照组60例。观察组采用局麻下免逆行插管并Y型负压吸引鞘行PCNL治疗，对照组采用椎管内麻醉下普通常压鞘下行PCNL治疗。比较两种不同麻醉及治疗方式下手术出血量、麻醉及手术时间、清石率、疼痛分级、术后进食时间、术后住院时间、治疗费用及并发症等。 结果观察组麻醉及手术时间、术后进食时间、术后住院时间及治疗费用等明显少于对照组（P<0.05）；两组间手术出血量、疼痛分级、清石率及并发症的比较，差异无统计学意义（P>0.05）。 结论对于肾及输尿管上段单颗或简单多颗结石，采用局麻免逆行插管Y型负压吸引鞘行PCNL优于椎管内麻下普通鞘行PCNL，值得在临床推广应用。

Analysis of the effect of Y-shaped negative pressure suction sheath on percutaneous nephrolithotomy without retrograde intubation under local anesthesia

ObjectiveTo observe the effect of percutaneous nephrolithotomy (PCNL) with Y-shaped suction sheath under local anesthesia without retrograde intubation. Methods120 cases with single or simple multiple ureteral calculi from renal hilus or above the third lumbar transverse process were included, matched and divided into observation group (60 cases) and control group (60 cases). The observation group was treated with PCNL without retrograde intubation and Y-shaped negative pressure suction sheath under local anesthesia while control group experienced PCNL under general normal pressure sheath under spinal anesthesia. Then the differences between the two anesthesia and treatment modes were compared, including operative blood loss, duration of anesthesia and surgery, stone free rate, pain grading, postoperative feeding time and hospital stay, treatment costs and complication. ResultsThe anesthesia and operation time, postoperative feeding time and hospital stay and treatment cost of the observation group were significantly less than those of the control group (P<0.05), while there was no significant difference in the operative blood loss, pain grading, stone free rate and complications between the two groups (P>0.05). ConclusionFor patients with single or simple multiple stones in kidney and upper segment of ureter, PCNL with Y-shaped negative pressure suction sheath under local anesthesia without retrograde is better than PCNL under general normal pressure sheath under spinal anesthesia, which worth clinical application.