Objective:This study was designed to evaluate the feasibility,efficacy,and safety of percutaneous ureteroscopy laser unroofing as an ambulatory surgery for symptomatic simple renal cysts under multilevel paravertebral...Objective:This study was designed to evaluate the feasibility,efficacy,and safety of percutaneous ureteroscopy laser unroofing as an ambulatory surgery for symptomatic simple renal cysts under multilevel paravertebral nerve block anesthesia.Methods:From December 2015 to September 2017,33 simple renal cyst patients who had surgical indications were enrolled.Under ultrasound guidance,the T10/T11,T11/T12,and T12/L1 paravertebral spaces were identified,and 7-10 mL 0.5%ropivacaine was injected at each segment.Then a puncture needle was placed inside the cyst cavity under ultrasonic monitoring.A guidewire was introduced followed by sequential dilation up to 28/30 Fr.The extra parenchymal portion of the cyst wall was dissociated and incised using a thulium laser,and a pathological examination was performed.Results:Sensory loss to pinprick from T8 to L1 and sensory loss to ice from T6 to L2 were observed in all patients.None of the patients complained of pain during surgery.No serious complications occurred perioperatively.After the surgery,all patients recovered their lower limb muscle strength quickly,got out of bed,resumed oral feeding,and left the hospital within 24 h of admission.The pathologic diagnosis of all cyst walls was a simple renal cyst.The mean follow-up was 35.8 months.At the end of follow-up,the cyst units were reduced in size by more than 50%compared to the preoperative size,and no patient experienced a recurrence.Conclusion:Multi-level paravertebral nerve block for percutaneous ureteroscopy laser unroofing as an ambulatory surgery mode is feasible,safe,and effective for the treatment of simple renal cysts in selected patients.展开更多
目的比较超声引导下锁骨上臂丛阻滞与肌间沟臂丛阻滞麻醉的效果。方法应用随机分组方法将2017年1月—2018年4月该院收治的行单侧上肢手术患者60例平均分为两组,给予观察组超声引导下锁骨上臂丛阻滞麻醉,给予对照组超声引导下肌间沟臂丛...目的比较超声引导下锁骨上臂丛阻滞与肌间沟臂丛阻滞麻醉的效果。方法应用随机分组方法将2017年1月—2018年4月该院收治的行单侧上肢手术患者60例平均分为两组,给予观察组超声引导下锁骨上臂丛阻滞麻醉,给予对照组超声引导下肌间沟臂丛阻滞麻醉,对比研究两组患者的麻醉效果各指标。结果与对照组相比,观察组的神经阻滞效果满意率[100.0%(30) vs 76.7%(23)](χ~2=26.372,P=0.000)、麻醉起效时间[(4.9±0.7)min vs(3.2±0.5)min](t=10.824,P=0.000)、疼痛阻滞持续时间[(6.8±1.6)h vs (3.7±1.1)h](t=8.745,P=0.000)、运动阻滞起效时间[(7.1±0.7)min vs (6.4±0.6)min](t=4.159,P=0.000)、运动阻滞持续时间[(5.7±1.4)h vs (3.6±0.8)h](t=7.133,P=0.000)、麻醉消退时间[(1.2±0.5)h vs (0.5±0.2)h](t=7.119,P=0.000)显著较高,神经刺激征频次[(1.4±0.3)次vs(2.0±0.4)次](t=6.572,P=0.000)显著较低,组间差异有统计学意义(P<0.05)。结论针对单侧上肢手术患者给予超声引导下锁骨上臂丛阻滞有较高的神经阻滞麻醉满意率,但其术后麻醉程度较深,必须做好实时监护工作,临床上推广应用很有价值。展开更多
文摘Objective:This study was designed to evaluate the feasibility,efficacy,and safety of percutaneous ureteroscopy laser unroofing as an ambulatory surgery for symptomatic simple renal cysts under multilevel paravertebral nerve block anesthesia.Methods:From December 2015 to September 2017,33 simple renal cyst patients who had surgical indications were enrolled.Under ultrasound guidance,the T10/T11,T11/T12,and T12/L1 paravertebral spaces were identified,and 7-10 mL 0.5%ropivacaine was injected at each segment.Then a puncture needle was placed inside the cyst cavity under ultrasonic monitoring.A guidewire was introduced followed by sequential dilation up to 28/30 Fr.The extra parenchymal portion of the cyst wall was dissociated and incised using a thulium laser,and a pathological examination was performed.Results:Sensory loss to pinprick from T8 to L1 and sensory loss to ice from T6 to L2 were observed in all patients.None of the patients complained of pain during surgery.No serious complications occurred perioperatively.After the surgery,all patients recovered their lower limb muscle strength quickly,got out of bed,resumed oral feeding,and left the hospital within 24 h of admission.The pathologic diagnosis of all cyst walls was a simple renal cyst.The mean follow-up was 35.8 months.At the end of follow-up,the cyst units were reduced in size by more than 50%compared to the preoperative size,and no patient experienced a recurrence.Conclusion:Multi-level paravertebral nerve block for percutaneous ureteroscopy laser unroofing as an ambulatory surgery mode is feasible,safe,and effective for the treatment of simple renal cysts in selected patients.
文摘目的比较超声引导下锁骨上臂丛阻滞与肌间沟臂丛阻滞麻醉的效果。方法应用随机分组方法将2017年1月—2018年4月该院收治的行单侧上肢手术患者60例平均分为两组,给予观察组超声引导下锁骨上臂丛阻滞麻醉,给予对照组超声引导下肌间沟臂丛阻滞麻醉,对比研究两组患者的麻醉效果各指标。结果与对照组相比,观察组的神经阻滞效果满意率[100.0%(30) vs 76.7%(23)](χ~2=26.372,P=0.000)、麻醉起效时间[(4.9±0.7)min vs(3.2±0.5)min](t=10.824,P=0.000)、疼痛阻滞持续时间[(6.8±1.6)h vs (3.7±1.1)h](t=8.745,P=0.000)、运动阻滞起效时间[(7.1±0.7)min vs (6.4±0.6)min](t=4.159,P=0.000)、运动阻滞持续时间[(5.7±1.4)h vs (3.6±0.8)h](t=7.133,P=0.000)、麻醉消退时间[(1.2±0.5)h vs (0.5±0.2)h](t=7.119,P=0.000)显著较高,神经刺激征频次[(1.4±0.3)次vs(2.0±0.4)次](t=6.572,P=0.000)显著较低,组间差异有统计学意义(P<0.05)。结论针对单侧上肢手术患者给予超声引导下锁骨上臂丛阻滞有较高的神经阻滞麻醉满意率,但其术后麻醉程度较深,必须做好实时监护工作,临床上推广应用很有价值。
