经皮肾镜取石术日间手术的初步报告

Preliminary report of day surgery of percutaneous nephrolithotomy

摘要:

目的 探索局麻下经皮肾镜取石术（PCNL）日间手术的有效性和安全性。方法 选取2019年1月－2019年12月于该院接受治疗并行PCNL的上尿路结石患者65例。其中，观察组30例，行局麻下PCNL；对照组35例，常规住院行硬膜外麻醉下PCNL。年龄18～60岁，结石直径 ≤ 3.0 cm，术前无尿路感染和其他合并症，肾积水为中度以下（肾盂分离度 ≤ 3.0 cm）。两组年龄、性别、侧别、结石直径和结石位置比较，差异均无统计学意义（P > 0.05）。观察两组手术时间（含麻醉时间）、住院时间、术后血红蛋白下降值、术后疼痛评分、住院费用、并发症发生情况和术后1个月结石取净率。结果 两组均顺利完成手术，观察组手术时间、住院时间和住院费用均明显少于对照组（P < 0.05），两组术后血红蛋白下降值、疼痛评分和结石取净率比较，差异均无统计学意义（P > 0.05）；观察组术后发热2例（BT < 38℃），自行恢复，对照组术后发热2例，拔造瘘管时切口出血1例，经局部压迫未再出血，两组并发症发生率比较，差异无统计学意义（P > 0.05）。结论 对于部分选择性的上尿路结石患者采用局麻下PCNL日间手术，可以缩短住院时间、减少住院费用，且不会增加手术风险，能达到快速康复的目的。但其适应证和操作流程尚需进一步探索和规范。

Abstract:

Objective To explore the efficacy and safety of day surgery of percutaneous nephrolithotomy (PCNL) under local anesthesia.Methods From January 2019 to December 2019, 65 patients with upper urinary tract calculi qualified for PCNL operation were selected. 30 patients in the observation group underwent PCNL day sugery under local anesthesia; 35 patients in the control group, PCNL was performed under epidural anesthesia. The patients were 18~60 years old. The maximum diameter of calculi ≤ 3.0 cm. There was no urinary tract infection and other complications before operation. Hydronephrosis was less than moderate (pelvis separation ≤ 3.0 cm). There was no significant difference in age, gender, side, stone diameter and stone location between the two groups (P > 0.05). The operation time (including anesthesia time), hospitalization time, postoperative hemoglobin reduction, postoperative pain score, hospitalization cost, incidence of complications and stone-free rate one month after operation were observed.Results All of the operations were successfully. The operation time, hospitalization time and hospitalization cost in observation group were significantly lower than those in the control group (P < 0.05). There was no significant difference in hemoglobin reduction, pain score and stone -free rate between the two groups (P > 0.05); There were 2 cases of fever (BT < 38℃) after operation in observation group, which recovered spontaneously without special treatment. There were 2 cases of fever after operation in control group, 1 case of incision hemorrhage when extubated fistula, no further bleeding after local compression. There was no significant difference in the incidence of complications between the two groups (P > 0.05).Conclusion For some selective upper urinary tract stones, PCNL day surgery under local anesthesia can shorten the hospitalization time, reduce the cost of hospitalization, and do not increase the risk of surgery, and can achieve the purpose of rapid recovery. But its indications and operation process need to be further explored and standardized.