孤立肾肾结石微创治疗的现状及进展

Current Situation and Development of Minimally Invasive Treatment of Solitary Kidney Calculi

孤立肾肾结石并不少见,病情更危重,病情复杂,处置较棘手,对手术质量要求较高,并发出血、感染风险更高。微创手术仍为处理孤立肾肾结石的首选方法,主要可分为体外冲击波碎石术、经皮肾镜、输尿管镜三类,其中体外冲击波碎石术主要用于经皮肾镜、输尿管镜术后结石残留及复发的治疗,经皮肾镜、输尿管镜、手术各有优劣,前者结石清除率高,后者并发症发生率低。孤立肾肾结石微创治疗中内镜使用技术基本成熟,但仍在不断改进发展中,包括术中影像学引导、冲洗、联合治疗,有关不同技术的近远期疗效、并发症、对肾功能影响是研究重点。

Isolated kidney stones are not rare, but the condition is more serious and complicated, so the disposal is more difficult with higher demand for surgery due to the higher risk of bleeding and infection. Minimally invasive surgery is the preferred method of solitary kidney calculi which can be mainly divided into three categories of extracorporeal shock wave lithotripsy（ESWL）, pereutaneous nephrolithotomy and ureteroscopy, and the ESWL is mainly used for residual stones recurrent calculi after percutaneous nephrolithotomy, ureteroscopy. The percutaneous nephrolithotomy, ureteroscopy each has own advantages and disadvantages, that the former stone clearance rate is higher, the latter complication occurrence rate is lower. The minimally invasive endoscopic technology for treatment of solitary kidney calculi is basically mature, but is still in the continuous improvement and development, including intraoperative image guidance, flushing and combined therapy. The short-term and long-term curative effect of different techniques, complications, and effects on renal function are the main research interests in the field.