CAJ | 학술논문

目的：通过对局麻微创经皮肾镜治疗肾结石及输尿管上段结石导致的全身炎症反应、肾功能损害等临床资料进行分析，评估局麻微创经皮肾镜的安全性、有效性、可行性、经济效益及其临床推广应用价值。方法东莞市大朗医院泌尿外科在2012年8月至2014年8月将经皮肾镜患者随机分成观察组及对照组（各40例），观察组行局麻，对照组行腰硬联合麻醉。对比两组术前晨、手术结束时及术后一周血清白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、β2-微球蛋白（β2-MG）、C-反应蛋白（CRP）、肌酐（Cr）及尿素氮（BUN）的表达水平；同时对比两种麻醉状态对患者心率（HR）、血氧饱和度（SPO2）及平均动脉压（MAP）的影响；并比较两组间手术时间、术中出血量、住院时间、住院费用及残石率的差异。结果两组患者术前晨血 BUN、Cr、β2-MG、IL-6、TNF-α及 CRP 组间比较差异无统计学意义（P>0.05），两组各项参考指标在手术结束时明显高于术前。对照组术后一周血清IL-6、TNF-α、CRP 含量高于观察组，两组术后一周血清 BUN、Cr、β2-MG 低于术前，差异有统计学意义（P<0.05）。观察组及对照组MAP、HR、SPO2在手术开始前、手术中与麻醉前比较差异有统计学意义（P<0.05）。两组间手术时间、术中出血量及残石率比较无统计学差别（P>0.05），观察组住院时间及住院费用明显低于对照组，差异有统计学意义（P<0.05）。结论局麻微创经皮肾镜治疗肾结石及输尿管上段结石引起的全身炎症反应较轻，总费用及住院时间明显低于腰硬联合麻醉组，两组患者肾功能损伤差别无统计学意义。
목적：통과대국마미창경피신경치료신결석급수뇨관상단결석도치적전신염증반응、신공능손해등림상자료진행분석，평고국마미창경피신경적안전성、유효성、가행성、경제효익급기림상추엄응용개치。방법동완시대랑의원비뇨외과재2012년8월지2014년8월장경피신경환자수궤분성관찰조급대조조（각40례），관찰조행국마，대조조행요경연합마취。대비량조술전신、수술결속시급술후일주혈청백개소-6（IL-6）、종류배사인자-α（TNF-α）、β2-미구단백（β2-MG）、C-반응단백（CRP）、기항（Cr）급뇨소담（BUN）적표체수평；동시대비량충마취상태대환자심솔（HR）、혈양포화도（SPO2）급평균동맥압（MAP）적영향；병비교량조간수술시간、술중출혈량、주원시간、주원비용급잔석솔적차이。결과량조환자술전신혈 BUN、Cr、β2-MG、IL-6、TNF-α급 CRP 조간비교차이무통계학의의（P>0.05），량조각항삼고지표재수술결속시명현고우술전。대조조술후일주혈청IL-6、TNF-α、CRP 함량고우관찰조，량조술후일주혈청 BUN、Cr、β2-MG 저우술전，차이유통계학의의（P<0.05）。관찰조급대조조MAP、HR、SPO2재수술개시전、수술중여마취전비교차이유통계학의의（P<0.05）。량조간수술시간、술중출혈량급잔석솔비교무통계학차별（P>0.05），관찰조주원시간급주원비용명현저우대조조，차이유통계학의의（P<0.05）。결론국마미창경피신경치료신결석급수뇨관상단결석인기적전신염증반응교경，총비용급주원시간명현저우요경연합마취조，량조환자신공능손상차별무통계학의의。
Objective To investigate clinical data of 80 cases with upper urethral stones and kidney stones under minimally invasive percutaneous nephroscope, and assess the safety, efficacy, feasibility, economic and clinical application value of local anesthesia for this surgery. Methods 80 cases were randomly divided into observation group and control group (40 cases each group). The observation group underwent minimally invasive percutaneous telephotography lithography with local anesthesia, while the control group underwent epidural anesthesia. The expressions of IL-6, TNF-α, β2-MG, CRP, Cr and BUN were detected in preoperative morning, postoperative and one week after operation. HR, SPO2, MAP, operation time, intraoperative blood loss, average length of hospital stay and hospital costs, residual stone rate were compared between the two groups. Results BUN, Cr, β2-MG, IL-6, TNF-α and CRP were not statistically significant different between the two groups in preoperative morning (P>0.05), but the postoperative expressions were significantly higher than preoperative. One week after surgery, IL-6, TNF-αand CRP of observation group slightly higher than control group. BUN, Cr, β2-MG were lower in one week after surgery than preoperative in both groups (P<0.05). MAP, HR, SPO2 were statistically significant difference in preoperative, intraoperative and before anesthesia (P<0.05). Operation time and blood loss was not statistically observation significant difference (P>0.05)between the two groups. The average length of stay and hospital costs in group were significantly lower than the control group(P<0.05). Conclusion Minimally invasive percutaneous telephotography under local anesthesia for kidney stones and upper urethral calculi is worthy of clinical application, because of less systemic inflammatory response, lower total cost and shorter length of hospital stay.