摘要
全身麻醉(GA)下输尿管软镜碎石术(FURL)在肾结石及输尿管上段结石的治疗中占据着重要地位,但部分患者无法耐受GA。局部麻醉(LA)因其安全性及有效性,近年来在临床上已逐渐成为GA的可行替代方式,也是部分≤20 mm、结石脆性较高、计算机断层扫描值较低、配合度较高人群的可选麻醉方式。术前完善相关检查、评估患者状态、进行抗感染预防,以及留置输尿管支架对LA下FURL的成功实施具有重要意义。术中需根据患者的具体情况灵活选择截石位、剪刀位、俯卧分腿位等体位,使用LA药物控制患者的生理疼痛、缓解心理焦虑,关注并调控患者的呼吸状态,同时选用合适的输尿管镜及镜鞘,为手术的成功实施与安全保驾护航。本文对LA下FURL围手术期管理进行了简要总结,为临床提供参考。
Flexible ureteral lithotripsy(FURL)under general anesthesia(GA)is the dominant method in the treatment of renal and upper ureteral calculi,but some patients cannot tolerate GA.In recent years,there has been a growing interest in the use of local anesthesia(LA)as a safe and effective alternative.And it is also an option for patients who have calculi≤20 mm with high fragility,lower CT value and better compatibility.Before surgery,it is important to conduct relevant examinations,evaluate the status of patients,prevent infections,and indwell ureteral stents.During surgery,lithotomy position,scissors position,prone leg position and other positions should be selected according to the specific conditions of patients.LA drugs should be used to control physiological pain and relieve psychological anxiety.Patients'breathing state should be carefully monitored,and appropriate ureteroscope and lens sheath should be selected for the success and safety of the operation.In this paper,the perioperative management of FURL under LA is briefly summarized,so as to provide reference for clinical practice.
作者
余朝林
谢平波
彭家玺
周红庆
罗永华
戴子涵
刘传
YU Chaolin;XIE Pingbo;PENG Jiaxi;ZHOU Hongqing;LUO Yonghua;DAI Zihan;LIU Chuan(Department of Urology,The Affiliated Qujing Hospital of Kunming Medical University,Qujing 655000,China)
出处
《现代泌尿外科杂志》
2025年第3期266-271,共6页
Journal of Modern Urology
基金
昆明医科大学2023年研究生创新基金项目(No.2023S405)。
关键词
泌尿系结石
输尿管软镜碎石术
局部麻醉
全身麻醉
围手术期管理
快速康复理念
视觉模拟评分
高危患者
结石清除率
urinary calculi
flexible ureteral lithotripsy
local anesthesia
general anesthesia
perioperative management
enhanced recovery after surgery
visual analogue scale
high-risk patients
stone-free rate
