两种取石术在日间手术模式下治疗1至2 cm肾结石的疗效分析

Study on the efficacy of two kinds of lithotomy in the treatment of 1 to 2 cm kidney stones in the day surgery

摘要:

目的 比较日间手术模式下行局部麻醉超微经皮肾镜取石术（SMP）和全身麻醉逆行输尿管软镜碎石取石术（RIRS）的疗效及可行性。方法 回顾性分析2021年6月－2022年6月该院泌尿外科100例行日间手术的肾结石患者的临床资料，结石直径1至2 cm，按术式分为局部麻醉SMP组（SMP组）和全身麻醉RIRS组（RIRS组），各50例。比较两组患者手术时间、术后结石清除率和并发症发生率等指标。结果 所有患者均成功行日间手术，无严重并发症发生，SMP组结石清除率高于RIRS组（96.0%和82.0%，P = 0.025），手术时间短于RIRS组［（34.86±8.10）和（45.66±9.62）min，P = 0.000］，RIRS组血红蛋白和红细胞比容下降较少（P < 0.05）。两组患者视觉模拟评分（VAS）、并发症发生率、住院时间、感染指标、血清肌酐变化和Clavien-Dindo分级系统比较，差异均无统计学意义（P > 0.05）。结论 经严格筛选合适的患者，在日间手术模式下开展局部麻醉SMP和全身麻醉RIRS均安全可行，彼此各有优势，SMP能有效提高近期结石清除率，RIRS能有效减少术中出血量，可根据实际情况合理选择。

Abstract:

Objective To compare the efficacy and feasibility of super-mini percutaneous nephrolithotomy (SMP) with local anesthesia and retrograde intrarenal stone surgery (RIRS) with general anesthesia in the day surgery mode.Methods From June 2021 to June 2022, 100 patients with kidney stones who underwent day surgery were studied retrospectively. The stones size ranged from 1 to 2 cm. They were divided into two groups based on the surgical method: SMP with local anaesthetic and RIRS with general anesthesia, with 50 cases in each. The two groups were compared in terms of surgery time, postoperative stone-free rate, and complication rate.Results All these patients underwent successful day surgery without serious complications. The SMP group had a higher rate of stone clearance than the RIRS group (96.0% vs 82.0%, P = 0.025), and the mean operation time was shorter than the RIRS group [(34.86 ± 8.10) vs (45.66 ± 9.62) min, P = 0.000]. The changes of hemoglobin and hematocrit in the RIRS group decreased less than those of SMP group (P < 0.05). There was no significant difference in the visual analogue scale (VAS), complication rate, length of hospital stay, infection indexes, serum creatinine changes and Clavien-Dindo grading system between the two groups (P > 0.05).Conclusion SMP with local anesthesia and RIRS with general anesthesia are both safe and practicable for suitable patients following thorough screening, SMP can effectively increase the recent stones removal rate. RIRS can effectively reduce the amount of bleeding during the operation. It can be reasonably selected according to the actual situation.