Influence Of Minimally Invasive Percutaneous Nephroscope With Local Anesthesia On Systemic Inflammatory Response And Renal Function Damage

Objective:To compare the clinical data of inflammatory response and renalfunction damage by renal calculi and upper ureteral calculi were treated by minimally invasive percutaneous nephrolithotomy under local anesthesia and general anesthesia,and assess the effectiveness and safety of MPCNL under local anesthesia.Method:1 A total of 60 cases treated by MPCNL from December 2015 to June2017 in our hospital were randomly divided into local anesthesia group and general anesthesia group(30 cases each group).The levels of WBC,C-reactive protein(CRP),procalcitonin(PCT),serum creatinine(Cr)and blood urea nitrogen(BUN)were compared between the two groups postoperative and 24h after operation.At the same time operation time,intraoperative blood loss,average length of hospital stay and hospital costs,residual stone rate were compared between the two groups.At the same time,the mean operation time,intraoperative blood loss,primary and final stone clearance rate,postoperative complication rate and visual acuity pain score(VAS)were compared between the two groups.2 Statistical methods:Using SPSS17.0 statistical software to process the data,The measurement data were expressed as mean±standard deviation(x±SD),The t-test was used to compare the two groups(the data of both groups obey the normal distribution).The count data usingχ~2 test.P<0.05 for the difference was statistically significant.Results:1 WBC,CRP,PCT,Cr and BUN were not statistically significant different between the two groups in preoperative.Indicators in postoperative were higher than in preoperative.The CRP in the local anesthesia group was lower than that in the general anesthesia group in postoperative.[(9.67±1.44)mg/L vs(11.43±1.47)mg/L,P=0.003].The PCT in the anesthesia group was lower than that in the general anesthesia group[(0.282±0.113)ng/ml vs(0.583±0.274)ng/ml,P=0.001].There was significant difference between the two groups(P<0.05).2 The mean operative time,intraoperative blood loss,the stone clearance rate of primary and final,postoperative nausea and bleeding,total hospital stay,VAS score had no significant difference(P>0.05).The postoperative fever e rate in local anesthesia group was significantly lower than that in general anesthesia group[20%(6/30)vs 53%(16/30),P=0.007].3 The patients with residual stones in both groups were treated with ESWL combined with drug therapy.There was no significant difference in thstone clearance rate at 1 month after operation(P>0.05).In the general anesthesia group,delayed hemorrhage occurred after removal of the renal fistula on the 4th day after the operation,with no significant improvement in the blood transfusion,persistent gross hematuria and local renal artery occlusion undergoing selective renal artery embolization,and gradually improved after operation.The rest were no serious anesthesia or surgical complications.Conclusion:The use of MPCNL under local anesthesia to treat kidney stones and upper ureteral calculi have lighter inflammation incidence,lower fever rate,higher comfort level,and there was no significant effect on the success rate of the operation.There was no significant difference in renal function between the two groups.