[1]张伦中,许良余,陈善群,等.局麻加强化麻醉下微创经皮肾镜取石术治疗上尿路结石[J].中国微创外科杂志,2011,11(5):428-430.
　Zhang Lunzhong,Xu Liangyu,Chen Shanqun,et al.Minimally Invasive Percutaneous Nephrolithotomy under Potentiated Local Anesthesia for Upper Urinary Calculi[J].Chinese Journal of Minimally Invasive Surgery,2011,11(5):428-430.
点击复制

局麻加强化麻醉下微创经皮肾镜取石术治疗上尿路结石()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
11
期数:
2011年5期
页码:
428-430
栏目:
出版日期:
2011-05-20

文章信息/Info

Title:
Minimally Invasive Percutaneous Nephrolithotomy under Potentiated Local Anesthesia for Upper Urinary Calculi
作者:
张伦中; 许良余; 陈善群; 陈晓峰; 李强郭小勇; 李解方
南华大学附属郴州市第一人民医院泌尿外科，郴州423000
Author(s):
Zhang Lunzhong;  Xu Liangyu;  Chen Shanqun;  et al.
Department of Urology, First People’s Hospital of Chenzhou, South China University, Chenzhou 423000, China
关键词:
局部麻醉; 强化麻醉; 经皮肾镜取石术; 尿路结石
Keywords:
Local anesthesia; Potentiated anesthesia; Percutaneous nephrolithotomy (PCNL); Urinary calculus
分类号:
R692.4;R693+.4
文献标志码:
A
摘要:
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。
Abstract:
ObjectiveTo assess the feasibility and superiority of minimally invasive percutaneous nephrolithotomy (MPCNL) in treating upper urinary calculi under potentiated local anesthesia. MethodsWe 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. ResultsThe 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. ConclusionMPCNL is feasible and effective for upper urinary calculi under potentiated local anesthesia for selected cases.

参考文献/References:

[1]Duvdevani M,Razvi H,Sofer M,et al.Third prize: contemporary percutaneous nephrolithotripsy:1585 procedures in 1338 consecutive patients.J Endourol，2007，21:824-829.
[2]AlKohlany KM,Shokeir AA,Mosbah A,et al.Treatment of complete staghorn stones:a prospective randomized comparison of open surgery versus percutaneous nephrolithotomy.J Urol，2005，173:469-473.
[3]杨航,王庆堂,邓超雄，等.局麻下微创经皮肾穿刺钬激光碎石治疗肾结石.临床泌尿外科杂志，2006,21(10):738-742.
[4]涂响安,梁辉,王文卫，等.B超引导下微创经皮肾镜碎石术治疗肾盏结石.中国微创外科杂志，2010,10(5):426-428.
[5]姚泰，主编.生理学.第5版.北京:人民卫生出版社,2002.287-366.
[6]Tai CK,Li SK,Fung TC,et al.Measurement of renal intrapelvic pressure during minimally invasive percutaneous nephrolithotomy (MPCNL),using pressurised irrigation of 350 mm Hg.Eur Urol Suppl,2008,7(3):190.
[7]Beiko D，Lee L.Out patient tubeless percutaneous nephrolithotomy:the initial case series.Can Urol Assoc J，2010，4(4):E86-E90.

备注/Memo

备注/Memo:
李解方（南华大学附属第一医院泌尿外科，衡阳421001）
更新日期/Last Update: 2013-04-18