微创麻醉下的微创手术：喉罩是否足以用于仰卧位经皮肾镜取石术？
Minimally invasive surgery via minimally invasive anesthesia Is laryngeal mask airway sufficient for supine percutaneous nephrolithotomy?
文献信息
| PMID | 42900889 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Ziv Savin |
| 作者单位 | Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States. |
| 期刊 | Canadian Urological Association journal = Journal de l'Association des urologues du Canada |
| SCI 分区 | Q3 |
| IF | 2.1 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
引言： 虽然气管插管（ETT）是经皮肾镜取石术（PCNL）的传统气道方式，但仰卧位体位的采用为替代策略打开了大门。喉罩气道（LMA）具有潜在优势，但其在仰卧位PCNL中的安全性仍研究不足。本研究旨在比较接受超声引导下仰卧位PCNL患者中LMA与ETT在泌尿外科和麻醉相关结局方面的差异。
方法： 在这项回顾性研究中，分析了2023年3月至2024年6月期间接受全身麻醉下仰卧位PCNL的206例成年患者。患者按气道方式分组：LMA组（n=156）或ETT组（n=50）。排除标准包括体重指数（BMI）>35 kg/m2、美国麻醉医师协会（ASA）评分≥4、慢性阻塞性肺疾病（COPD）、妊娠或数据不完整。泌尿外科结局包括术中并发症、30天并发症和术后疼痛。麻醉相关结局包括血流动力学不稳定、麻醉后监护室（PACU）停留时间、气道置入/拔除时间以及麻醉相关并发症。比较两组之间的结局，并使用多变量回归和敏感性分析来校正混杂因素。
结果： LMA组总体并发症显著较低（13% vs. 28%，p=0.01），且在单变量分析中LMA与并发症呈负相关（比值比[OR] 0.378，95%置信区间[CI] 0.174-0.821，p=0.01）。在对术前危险因素、结石特征和术中因素进行事后校正后，使用LMA仍与总体麻醉和泌尿外科并发症风险降低独立相关。LMA组的气道置入和拔除时间较短；除此之外，麻醉相关结局未观察到显著差异。没有因气道并发症而中止或中转的手术。
结论： 在我们有限的研究中，对于经过适当选择的接受仰卧位PCNL的患者，LMA似乎是ETT的一种安全有效的气道管理替代方案。需要前瞻性随机研究来证实这些发现。
英文摘要
INTRODUCTION: While endotracheal tube (ETT) is the traditional airway modality for percutaneous nephrolithotomy (PCNL), the adoption of supine positioning has opened the door for alternative strategies. Laryngeal mask airway (LMA) offers potential advantages, but its safety profile in supine PCNL remains understudied. This study aimed to compare urologic and anesthesia-related outcomes between LMA and ETT in patients undergoing ultrasound-guided supine PCNL.
METHODS: In this retrospective study, 206 adult patients undergoing supine PCNL under general anesthesia between March 2023 and June 2024 were analyzed. Patients were grouped by airway modality: LMA (n=156) or ETT (n=50). Exclusion criteria included body mass index (BMI) >35 kg/m2, American Society of Anesthesiologists (ASA) score ≥4, chronic obstructive pulmonary disease (COPD), pregnancy, or incomplete data. Urologic outcomes included intraoperative complications, 30-day complications, and postoperative pain. Anesthesia-related outcomes included hemodynamic instability, post-anesthesia care unit (PACU) stay, airway placement/removal times, and anesthesia-related complications. Outcomes were compared between the groups, and multivariable regression and sensitivity analysis were used to adjust for confounders.
RESULTS: Overall complications were significantly lower in the LMA group (13% vs. 28%, p=0.01), and LMA was negatively associated with them in univariable analysis (odds ratio [OR] 0.378, 95% confidence interval [CI] 0.174-0.821, p=0.01). LMA use remained independently associated with a reduced risk of overall anesthetic and urologic complications after ad-hoc adjustments for preoperative risk factors, stone characteristics, and intraoperative factors. Airway placement and removal times were shorter in the LMA group; otherwise, no significant differences were observed in anesthesia-related outcomes. No procedures were aborted or converted due to airway complications.
CONCLUSIONS: In our limited study, LMA seems to be a safe and effective alternative to ETT for airway management in appropriately selected patients undergoing supine PCNL. Prospective, randomized studies are needed to confirm these findings.