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目的探讨局部浸润麻醉下二期经皮肾镜取石治疗肾及输尿管上段结石的疗效及安全性。方法采用局部浸润麻醉加杜冷丁、非那根镇痛下行二期经皮肾镜取石治疗肾输尿管上段结石205例,其中,男性130例,女性75例,年龄18~72岁,平均43岁。其中左肾多发性结石59例,右肾多发性结石74例,双肾多发性结石50例,输尿管上段嵌顿性结石20例,孤立肾多发结石2例。结石直径1.2~7.3 cm,平均4.0 cm。结果1次取石108例,2次取石82例,3次取石15例。结石取净率91.7%,采用单通道取石195例,双通道取石10例。患者平均住院16 d。除15例感染性结石术后次日有短暂发热外,无术中术后大出血而需输血或中转开放手术,无水中毒、胸膜穿孔。发生1例结肠穿孔,拔除造瘘管自行愈合。结论局部麻醉下二期经皮肾镜取石治疗肾输尿管上段结石较安全,对机体内环境侵袭干扰小,治疗期间病人的护理及生活质量也提高,具有高效、经济、安全、并发症少等优点。尤其适合合并慢性肾功能不全尿毒症、贫血、感染性结石、肾盂积脓、孤立肾结石及高危的肾输尿管上段结石患者。
Objective To investigate the efficacy and safety of second percutaneous nephrolithotomy under partial infiltration anesthesia in the treatment of renal and upper ureteral calculi. Methods 205 cases of upper ureteral calculi were treated with local infiltration anesthesia plus pethidine and pinagoline analgesia. Two cases of upper ureteral calculi were treated by percutaneous nephrolithotomy, of which 130 were males and 75 were females, aged from 18 to 72 years with an average of 43 years. Of which 59 cases of multiple lesions of the left kidney, multiple lesions of the right kidney in 74 cases, 50 cases of multiple tuberculosis of the kidney, upper ureteral incarcerated stones in 20 cases, multiple isolated solitary stone in 2 cases. Stones diameter of 1.2 ~ 7.3 cm, an average of 4.0 cm. Results One stone was taken in 108 cases, two stones were taken in 82 cases and three stones were taken in 15 cases. The recovery rate of stones was 91.7%, using single-channel stone in 195 cases and double-channel stone in 10 cases. Patients were hospitalized for an average of 16 days. In addition to 15 cases of infectious stones on the next day after a brief fever, no intraoperative postoperative bleeding required transfusion or transit surgery, water poisoning, pleural perforation. One case of colonic perforation, removal of the fistula to heal. Conclusions The second stage of percutaneous nephrolithotomy under local anesthesia is safe for the treatment of upper ureteral calculi, which has less interference with the environment and has better patient care and quality of life during treatment. It has the advantages of high efficiency, economy, safety and less complications . Especially suitable for patients with chronic renal insufficiency uremia, anemia, infectious stones, pyonephrosis, isolated kidney stones and high-risk patients with upper ureteral calculi.