局麻下经皮肾碎石术对高危肾结石患者的疗效与安全性探讨

目的：探讨B超引导局麻下经皮肾取石对高危。肾结石患者的疗效与安全性。方法：依据术前美国麻醉医师协会（ASA）评分，将91例行局麻下经皮肾镜取石术肾结石患者分为高危组（ASAUI或Ⅳ）23例和低危组（ASAI或11）68例，所有患者均运用微通道（F18）PCNL钬激光碎石术。记录并比较两组年龄、体质指数、合并疾病数量、结石平均体积、手术时间、术中出血量、结石清除率、平均术后住院时间及手术并发症。结果：高危组与低危组的平均年龄（56．0士12．3）、（52．0±11．6）岁]、体质指数（29．2土4．5）、（28．5±4．8）]、结石总体积（3．12±1．13）、（3．27土1．45）cm^3]、术中平均估计失血量（126±20）、（112±23）m1]、手术时间（57±25）、（62±28）min]及主要并发症发生率（12．7％、13．5％）之间差异均无统计学意义（P〉0．05）。高危组与低危组在平均合并疾病数量（4．7±1．8）、（1．4±0．7）]、平均术后住院天数（8．5土3．7）、（6．2±2．3）d]、结石清除率（72．5％、91．3％）之间差异有统计学意义（P〈O．05）。结论：局麻下经皮肾取石对高危肾结石患者同样安全可行。

The safety and efficacy of percutaneous nephroIithotomy under local anesthesia in high-risk patients

To discuss The safety and efficacy of percutaneous nephroIithotomy under local anesthesia in high-risk patients, Method： The records of 99 consecutive PCNL procedures performed on 91 patients from August 2010 to June 2012 were enrolled in this study. According to preoperative American Society of Anesthesiologist （ASA） scores, patients were divided into a high-risk group with ASA Ⅲ or Ⅳ （ n =23） and a low-risk group with ASA Ⅱ orⅠ （ n = 68）, and all patients underwent PCNL with holmium laser through standard （F18） micro channel. Age, body mass index ,Operative time, length of hospital stay, blood loss, stone-free rate, and surgical complications were recorded and compared between two groups. Result： There were no significant differences in age （ 56±12.3 vs52±11. 6, P〉0.05）, body mass index （29.2±4.5 vs 28.5 ± 4.8, P〉0.05）, mean cumulative stone size （3.12±1.13 cm3 vs 3.27±1.45 cm3 , P〉0.05）, estimated blood loss （126±20 ml vs 112±23 ml, P〉0.05）, mean operative time （57±25 min vs 62±28 rain, P〉0.05） and the major complication rate （12.7 % vs 13.5 %, P〉0.05） between two groups. The high-risk group had significantly more comorbidities than the low-risk group （4.7±1.8 vs 1.4±0.7, P〈0.05）. Significant differences in the mean duration of postoperative hospital stay （8.5±3.7 d vs 6.2±2.3 d, P〈0.05） and stone-free rate （72.5% vs 91.3%, P〈0.05） with observed. Conclusion：PCNL under local anesthesia can be safely performed in the high-risk patients with kidney stones.