全麻与腰麻无管化经皮肾镜碎石取石术治疗肾结石的比较

目的探讨全麻与腰麻无管化经皮肾镜碎石取石术(PCNL)治疗肾结石的临床效果。方法前瞻性分析2017年8月至2017年12月我院65例行无管化经皮肾镜钬激光碎石取石术的患者的临床资料,术前采用随机数字表将患者分为全麻组与腰麻组,其中术中发生严重出血需留置肾造瘘管共12例被删除。最终53例行无管化PCNL的患者被纳入研究,其中全麻组28例,腰麻组25例,统计分析两组患者结石的基本特征、术中及术后的参数。结果两组患者在年龄、性别、体质量指数、结石大小、结石位置、手术时间、住院天数、穿刺针数、穿刺位置、血红蛋白下降、出院当天视觉模拟疼痛评分(VAS)及残石率差异无统计学意义(P>0.05),但腰麻组术后的第一天的VAS评分[(4.4±1.8)vs(6.4±2.0),P<0.05]及曲马多镇痛需求量[(56±36) mg vs (112±44) mg,P<0.05]显著小于全麻组。结论腰麻行无管化PCNL是全麻下无管化PCNL的良好替代方案,与全麻相比,腰麻术后疼痛更轻,减少了无管化PCNL患者术后镇痛需求。

Clinical analysis of general anesthesia and spinal anesthesia in tubeless percutaneous nephrolithotomy for the treatment of renal stones

ObjectiveTo investigate the clinical effects of general anesthesia and spinal anesthesia in percutaneous nephrolithotomy (PCNL) for the treatment of renal calculi. MethodsFrom August 2017 to December 2017, 53 patients underwent tubeless percutaneous nephrolithotomy with holmium laser. Patients were randomly divided into general anesthesia group and spinal anesthesia group before operation. The basic characteristics, intraoperative and postoperative parameters of the stones in the two groups were compared. ResultsThere were no significant differences in age, gender, body mass index (BMI), stone size, stone position, operation time, length of hospital stay, number of puncture needles, puncture position, hemoglobin decline, visual analog pain scores (VAS) and residual stone rate on discharge day (P>0.05). However, the VAS of first day after surgery [(4.4±1.8) vs (6.4±2.0), P<0.05] and the analgesic requirement of tramadol [(56±36) mg vs (112±44) mg, P<0.05] were significantly lower in the spinal anesthesia group than in the general anesthesia group. ConclusionThe tubeless PCNL under spinal anesthesia is a good alternative to the tubeless PCNL under general anesthesia. Compared with general anesthesia, the pain after spinal anesthesia is lighter, which reduces the postoperative analgesia in patients with tubeless PCNL.