摘要
目的:探讨局部麻醉下硬性输尿管镜手术的效果和经验。方法:2007年1月～2012年10月局部麻醉下行硬性输尿管镜手术65例。其中输尿管镜下碎石30例,双J管移位18例,血尿查因9例,上尿路积水查因8例。运用疼痛视觉模拟评分(visual analogue scale,VAS)评估麻醉效果。对照组30例采用椎管内麻醉。结果:对照组全部成功完成输尿管镜手术。局麻组65例患者中有54例成功完成输尿管镜手术,11例不能耐受者而改为静脉复合麻醉或椎管内麻醉后完成手术,成功率83%。局麻组与对照组的平均手术时间(包括麻醉时间)为18(10～40)minvs 40(25～70)min(P<0.01)。局麻组与对照组的VAS总体评分为(3.3±5.5)vs(2.5±3.8)(P=0.03)。但对于女性、相对年长的(≥50岁)、输尿管镜下取异物或取活检、病变位于输尿管中下段以及手术时间相对较短(<20min)的患者,局麻组手术的VAS评分与椎管内麻醉组无显著差异。结论:在严格的病例选择条件下,局部麻醉下输尿管镜手术方便、安全、有效,可作为输尿管疾病诊断和治疗的选择。
Objective： To evaluate the efficacy and safety of rigid ureteroscopy under local anesthesia. Method： Clinical data of 65 cases of ureteral disaeses treated with ureteroscopy under local anesthesia during January 2007 to October 2012 were analyzed. The 65 cases were composed of 30 ureteral calculi, 18 double-J stent migration, 9 hematuria and 8 hydronephrosis. Visual analogue scale （VAS） was used to evaluate the anesthesia effect. The 30 cases in control group were applied with intraspinal anesthesia. Result： Of the 65 cases, 54 were successfully trea ted with ureteroscopy under local anesthesia. 11 were treated with ureteroscopy after being changed to intraspinal anesthesia or balanced anesthesia. The achievement ratio was 83 %. The operating time and general VAS scores of local anesthesia group and control group were 18（10-40） min vs 40（25-70） min（P〈0.01）and （3.3±5.5） vs （2.5 ±3.8）（P=0.03）, respectively. But the VAS scores between the two groups had no significant difference according to femal cases, older patients（≥50 y）, uretroscopic examination or biopsy, middle to lower ureteral operations and shorter operating time（〈20 min）. Conclusion： In selected cases, ureteroscopy under local anesthesia is a convenient, safe and effective alternative for ureteral diseases.
出处
《临床泌尿外科杂志》
2013年第7期526-528,共3页
Journal of Clinical Urology
