Comparative study of minimally invasive percutaneous nephrolithotomy under local anesthesia and general anesthesia in the treatment of renal calculi in elderly patients
LI Yanmin1,2 WU Gengqing1,2
1.Department of Urology, the First Affiliated Hospital of Gannan Medical University, Jiangxi Province, Ganzhou 341000, China;
2.Jiangxi Engineering Research Center for Stone Prevention and Control, Jiangxi Province, Ganzhou 341000, China
Abstract：Objective To investigate the efficacy and safety of minimally invasive percutaneous nephrolithotomy (MPCNL) under local anesthesia and general anesthesia in the treatment of renal calculi in elderly patients. Methods From January 2019 to March 2020, 84 cases with unilateral renal calculi who received MPCNL treatment in the First Affiliated Hospital of Gannan Medical University were selected as study objects. They were divided into local anesthesia group (experimental group) and general anesthesia group (control group) according to the different anesthesia methods, with 42 patients in each group. 18 F cutaneous and renal channels were established by ultrasound-guided puncture, and holmium laser lithotripsy was performed in two groups. The operation time, postoperative fever, postoperative visual analogue scale (VAS) score, calculus residual rate, postoperative hospitalization time and hospitalization cost were compared between two groups. Results The operation time and postoperative hospitalization time of experimental group were shorter than those of control group, and VAS score and hospitalization cost were lower than those of control group, with statistically significant differences (all P < 0.05). There were no significant differences in the postoperative fever rate, calculus residual rate between two groups (P > 0.05). Conclusion Compared with MPCNL under general anesthesia, MPCNL under local anesthesia has the same therapeutic effect. MPCNL under local anesthesia has shorter operative time and hospitalization time, no need to resuscitate in the resuscitation room after surgery, less postoperative pain and hospitalization cost, which is worthy of clinical promotion and application.
黎衍敏1,2 伍耿青1,2. 局麻与全麻微创经皮肾镜取石术治疗老年肾结石的对比研究[J]. 中国医药导报, 2020, 17(22): 94-97.
LI Yanmin1,2 WU Gengqing1,2. Comparative study of minimally invasive percutaneous nephrolithotomy under local anesthesia and general anesthesia in the treatment of renal calculi in elderly patients. 中国医药导报, 2020, 17(22): 94-97.
[1] 卫超，张宇聪，甘家骅，等.标准经皮肾镜取石术与无管化经皮肾镜取石术治疗肾结石的比较研究[J].中华泌尿外科杂志，2018，39（7）：532-536.
[2] 王少刚，余虓.经皮肾镜碎石取石术的现状与进展[J].中华腔镜泌尿外科杂志：电子版，2016，10（3）：140-143.
[3] 章尹岗，刘文.经皮肾镜取石术并发出血的危险因素分析[J].中国内镜杂志，2018，24（6）：83-87.
[4] 罗启占，夏金玉，刘正，等.输尿管软镜治疗肾盏憩室结石及经皮肾镜治疗憩室结石的对比研究[J].中国内镜杂志，2015，21（4）：429-432.
[5] Li H，Xu K，Li B，et al. Percutaneous nephrolithotomy under local infiltration anesthesia：a single-center experience of 2000 Chinese cases [J]. Urology，2013，82（5）：1020-1025.
[6] Wei C，Zhang Y，Pokhrel G，et al. Research progress of percutaneous nephrolithotomy [J]. Int Urol Nephrol，2018，50（5）：807-817.
[7] 卢敏，黄剑焜，彭希哲.老年人口生活自理能力变迁与老年定义重新思考[J].南方人口，2018，33（1）：58-69.
[8] Wollin DA，Preminger GM. Percutaneous nephrolithotomy：complications and how to deal with them [J]. Urolithiasis，2018，46（1）：87-97.
[9] Ecke TH，Barski D，Weingart G，et al. Presentation of a method at the Exploration Stage according to IDEAL：Percutaneous nephrolithotomy（PCNL）under local infiltrative anesthesia is a feasible and effective method-retrospective analysis of 439 patients [J]. Int J Med Sci，2017，14（4）：302-309.
[10] 李春蕊，王天红，王晶晶，等.疼痛微创介入技术日间手术模式的实践与思考[J].中国疼痛医学杂志，2018，24（12）：917-920.
[11] 李建兴，肖博，唐宇哲，等.融合影像技术在超声定位经皮肾镜手术中的初步应用[J].中华泌尿外科杂志，2017， 38（9）：658-661.
[12] Ng FC，Yam WL，Lim TYB，et al. Ultrasound-guided percutaneous nephrolithotomy：Advantages and limitations [J]. Investig Clin Urol，2017，58（5）：346-352.
[13] Singh Dongol UM，Bohora S. Outcome of Percutaneous Nephrolithotomy in the Management of Lower Pole Stones [J]. J Nepal Health Res Counc，2018，16（3）：274-278.
[14] Steadman J，Catalani B，Sharp C，et al. Life threatening perioperative anesthetic complications：major issues surrounding perioperative morbidity and mortality [J]. Trauma Surg Acute Care Open，2017，2（1）：e000113.
[15] 张会朋，王艳波，赵明.经皮肾标准通道碎石在青年和老年肾结石患者中应用的比较[J].中国老年学杂志，2015，35（10）：2771-2773.
[16] Ghania KR，Andonian S，Bultitude M，et al. Percutaneous Nephrolithotomy：Update，Trends，and Future，Directions [J]. Eur Urol，2016，70（2）：382-396.
[17] 郑金华，谢进东，陈景宇，等.局麻联合强化麻醉下微创经皮肾镜术治疗上尿路结石的临床研究[J].中华腔镜泌尿外科杂志：电子版，2019，13（4）：263-266.
[18] 王兴源，麻立，贾光中.老年肾结石患者侧卧位在经皮肾镜手术中的应用效果[J].中国老年学杂志，2018，38（10）：2394-2396.
[19] Dundar G，Gokcen K，Gokce G，et al. The Effect of Local Anesthetic Agent Infiltration Around Nephrostomy Tract On Postoperative Pain Control After Percutaneous Nephrolithotomy：A single-centre，randomized，double-blind，placebocontrolled clinical trial [J]. Urol J，2018，15（6）：306-312.
[20] Carrion DM，Cansino JR，Quintana LM，et al. Prone percutaneous nephrolithotomy：its advantages and our technique for puncture [J]. Transl Androl Urol，2018，7（6）：950-959.
[21] Wang J，Zhang C，Tan D，et al. The Effect of Local Anesthetic Infiltration Around Nephrostomy Tract on Postoperative Pain Control after Percutaneous Nephrolithotomy：A Systematic Review and Meta-Analysis [J]. Urol Int，2016，97（2）：125-133.
[22] Guliev BG，Zaikin AY，Ismati O. The Infective Complications of the Percutaneous Nephrolithotomy [J]. Urologiia，2018，11（5）：128-133.
[23] Bultitude M，Thomas K. Predicting sepsis after percutaneous nephrolithotomy [J]. BJU Int，2019，123（6）：914-915.
[24] Caglayan V，Oner S，Onen E，et al. Percutaneous nephrolithotomy in solitary kidneys：effective，safe and improves renal functions [J]. Minerva Urol Nefrol，2018，70（5）：518-525.
[25] Abedali ZA，Large T，Heiman JM，et al. Percutaneous Nephrolithotomy in the 80 Years of Age and Older Population [J]. Urology，2019，134：62-65.
[26] 汪海龙，张宗平，王安果，等.X线与超声在经皮肾镜治疗复杂性肾结石中的应用比较[J].中华腔镜泌尿外科杂志：电子版，2019，13（2）：108-111.
2020, Vol. 17 
京公网安备 11010502046598号