肋间神经阻滞联合局麻微创经皮肾镜38例报告

目的探讨肋间神经阻滞联合局麻微创经皮肾镜碎石取石术（MPCNL）的可行性与安全性。 方法2018年10月至2019年11月，超声引导下于患侧第10、11、12肋骨下缘与脊柱交叉点处进行肋间神经阻滞，每个部位注射0.5%布比卡因5 ml（含1/1000肾上腺素），然后在选定的穿刺通道上进行局部浸润麻醉（2%利多卡因10 ml+生理盐水15 ml混合液约10 ml）。采用超声引导下穿刺、一步扩张法MPCNL，分别在钬激光碎石开始10 min及术后2 h、6 h、24 h行视觉模拟评分（VAS）评估疼痛严重程度；术后2 h及术后第1天复查血常规评估术中出血量；术后4周复查腹部平片或超声评估结石清除率。 结果38例均顺利完成手术，无一例需改变麻醉方式，无严重并发症发生，无一例中转开放手术，术中及术后2 h、4 h、24 h的VAS均值分别为2.6、2.2、1.8和1.3分，术后4周结石总体清除率91.3%（21/23）。 结论选择合适的病例，肋间神经阻滞联合局麻MPCNL操作简便，手术安全，疗效满意，值得临床推广。

Minimally invasive percutaneous nephrolithotomy under intercostal nerve block combined with local anesthesia: a report of 38 cases

ObjectiveTo explore feasibility and safety of minimally invasive percutaneous nephrolithotomy (MPCNL) under intercostal nerve block combined with local anesthesia. MethodsFrom October 2018 to November 2019, under the guidance of ultrasound, intercostal nerve blocks were performed at the intersection of the 10th, 11th, and 12th ribs of the affected side with the spine. 5 ml of 0.5% bupivacaine (containing 1/1 000 epinephrine) was injected at each site, and then local infiltration anesthesia on the selected puncture channel (2% lidocaine 10 ml + normal saline 15 ml mixed solution about 10 ml) was performed. Ultrasound guided puncture and one-step expansion of MPCNL was implemented, visual analogue scale (VAS) was used to assess pain severity. ResultsThe operations were successfully completed in 38 cases, no one needed to change the method of anesthesia, no serious complications occurred, and no case was converted to open surgery. The mean VAS scores during surgery and after 2 h, 4 h, and 24 h were 2.6, 2.2, 1.8, and 1.3 points respectively, the overall stone removal rate at 9 weeks was 91.3% (21/23). ConclusionsSelecting suitable cases, MPCNL under intercostal nerve block combined with local anesthesia is simple, safe and efficient.