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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(ASAⅢ或Ⅳ)23例和低危组(ASAⅠ或Ⅱ)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±12.3)、(52.0±11.6)岁]、体质指数[(29.2±4.5)、(28.5±4.8)]、结石总体积[(3.12±1.13)、(3.27±1.45)cm3]、术中平均估计失血量[(126±20)、(112±23)ml]、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±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<0.05)。结论:局麻下经皮肾取石对高危肾结石患者同样安全可行。
Objective: To investigate the efficacy and safety of percutaneous nephrolithotomy guided by local anesthesia with B-ultrasound in patients with high-risk nephrolithiasis. Methods: According to the preoperative ASA score, 91 patients undergoing percutaneous nephrolithotomy and kidney stones under local anesthesia were divided into high risk group (ASA Ⅲ or Ⅳ) and low risk group (ASA Ⅰ or Ⅱ) 68 cases, all patients were using microchannel (F18) PCNL holmium laser lithotripsy. Record and compare two groups of age, body mass index, the number of combined diseases, the average volume of stones, operation time, intraoperative blood loss, stone clearance rate, average postoperative hospital stay and surgical complications. Results: The average age of high risk group and low risk group [(56.0 ± 12.3), (52.0 ± 11.6) years], body mass index [(29.2 ± 4.5), (28.5 ± 4.8)], total volume of stones ), And (3.27 ± 1.45) cm3 respectively. The mean intraoperative blood loss was estimated as (126 ± 20) and (112 ± 23) ml, and the operative time was (57 ± 25) and (62 ± 28) min, respectively. The incidence of disease (12.7%, 13.5%) showed no significant difference (P> 0.05). The average number of combined disease in the high-risk group and the low-risk group was significantly lower than those in the low-risk group [(4.7 ± 1.8), (1.4 ± 0.7)], mean postoperative hospital stay [(8.5 ± 3.7), (6.2 ± 2.3) %, 91.3%), the difference was statistically significant (P <0.05). Conclusion: Percutaneous nephrolithotomy under local anesthesia is equally safe and feasible for high-risk nephrolithiasis patients.