国际尿石症联盟输尿管软镜碎石术指南解读

Interpretation of the International Alliance of Urolithiasis Guideline on retrograde intrarenal surgery

输尿管软镜碎石术(RIRS)广泛应用于临床,但也存在一些并发症影响其推广应用,迫切需要具有循证医学支持且详细的手术操作指南来指导并规范开展RIRS。国际尿石症联盟(IAU)制定了IAU-RIRS指南并在BJU International杂志上发表,本文对该指南的要点内容进行了解读,内容包括适应证和禁忌证、术前影像、尿路感染管理、抗血栓治疗的管理、输尿管预置管、手术麻醉与体位、安全导丝、输尿管通道鞘、软镜的选择、灌注、碎石取石、退出前输尿管镜检、术后评估、并发症预防与管理等。

Although retrograde intrarenal surgery(RIRS) is widely used in clinical practice, there are also some complications that affect its application. It is urgent to have evidence-based medical support and detailed operation guidelines to guide and standardize the implementation of RIRS. The International Alliance of Urolithiasis(IAU) has formulated the IAU-RIRS guideline and published in BJU International. The present paper aims to clarify the key points of the guidelines, including indications and contraindications, preoperative imaging, urinary tract infection management, management of antithrombotic therapy, prestenting, anesthesia and position, safety guide wire, ureteral access sheath, flexible ureteroscope, perfusion, lithotripsy, ureteroscopy before withdrawal, postoperative evaluation, prevention and management of complications, etc.