背景:传统上在全身麻醉(GA)下进行输尿管或肾结石的输尿管镜检查(URS)。镇静是GA的替代方案,允许控制意识水平,自发通气和更快的恢复。我们的目的是比较接受输尿管肾镜检查的患者的镇静和GA。终点为结石游离率(SFR)和并发症发生率。
方法:单中心回顾性对比研究,包括所有连续输尿管肾镜检查输尿管或肾结石。由于COVID-19大流行,纳入期分两个6个月:2019年1月1日至7月1日(GA下的URS)和2021年1月1日至7月1日(GA下的URS或镇静)。无结石(SF)状态定义为首次输尿管肾镜检查后无结石或碎片>4mm。根据SATAVA(围手术期并发症)和CLAVIEN-DINDO(术后并发症)分类评估并发症率。统计学分析采用卡方检验。
结果:共纳入185例患者,共进行206次输尿管镜检查;82例在GA下接受输尿管镜检查,103例在镇静下接受输尿管镜检查。中位结石大小为10[7-16]mm。150例(81%)患者至少有一块肾内结石。两组之间的SFR相似(67%GA组,69%镇静组,p=0.912)。在镇静组,输尿管平均SFR为83.7%,GA组为92.5%。在肾腔中,镇静组的平均SFR为46.4%,GA组为42.5%.SATAVA一级,IIa和IIb并发症为5(6%),GA组中5(6%)和1(1%)和6(6%),镇静组1(1%)和3(3%),分别(p=0.214)。一级,II,III和IVCLAVIEN并发症为6(7%),3(4%),GA组0(0%)和2(2%),6(6%),4(4%),镇静组1(1%)和4(4%),分别(p=0.928)。
结论:我们的COVID-19后研究显示,镇静下输尿管肾镜检查与GA对肾结石患者的疗效和安全性无差异。我们的结果证实了镇静程序的兴趣,特别是在门诊手术中。
BACKGROUND: Ureterorenoscopy (URS) for ureteral or renal stones is traditionally performed under general anesthesia (GA). Sedation is an alternative to GA, allowing control of the level of consciousness, spontaneous ventilation, and faster recovery. Our aim was to compare sedation and GA for patients undergoing ureterorenoscopy. Endpoints were stone-free rate (SFR) and complication rates.
METHODS: Monocentric comparative retrospective study including all consecutive ureterorenoscopies for ureteral or renal stone. The inclusion period was dichotomized in two 6-months periods due to the COVID-19 pandemic: from January 1 to July 1, 2019 (URS under GA) and from January 1 to July 1, 2021 (URS under GA or sedation). Stone-free (SF) status was defined as the absence of stone or fragment>4mm after the first ureterorenoscopy. Complication rates were assessed according to the Satava (perioperative complications) and Clavien-Dindo (postoperative complications) classifications. Statistical analysis was performed by Chi-square test.
RESULTS: A total of 185 patients were included for a total of 206 ureterorenoscopies; 82 underwent ureterorenoscopy under GA and 103 under sedation. The median stone size was 10 [7-16] mm. In all, 150 (81%) patients had at least one intrarenal stone. The SFR was similar between the two groups (67% GA group, 69% sedation group, P=0.912). In the sedation group, the mean SFR in ureter was 83.7% vs. 92.5% in the GA group. In renal cavities, the mean SFR was 46.4% in the sedation group vs. 42.5% in the GA group. Satava grade I, IIa, and IIb complications were 5 (6%), 5 (6%), and 1 (1%) in the GA group and 6 (6%), 1 (1%), and 3 (3%) in the sedation group, respectively (P=0.214). The grade I, II, III, and IV Clavien complications were 6 (7%), 3 (4%), 0 (0%), and 2 (2%) in the GA group and 6 (6%), 4 (4%), 1 (1%), and 4 (4%) in the sedation group, respectively (P=0.928).
CONCLUSIONS: Our post COVID-19 study showed no difference in efficacy and safety between ureterorenoscopy under sedation and GA for patients with renal stones. Our results confirm the interest of the sedation procedure, particularly in the context of outpatient surgery.
METHODS: