摘要:2022年8月,欧洲泌尿外科学会 (European Association of Urology,EAU) 更新了尿石症介入治疗的最 佳实践指南 (以下简称指南)。对上尿路结石的管理提供了最新的指导,并对外科治疗中有争议领域进行了讨 论。本文针对指南中更新的内容及临床意义进行总结和解读。
表 1 术前抗凝药物指导
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亓立成,楚宁.《2022 EAU 指南:尿石症介入治疗的最佳实践》解读[J]. 泌尿外科杂志(电子版),2022,14(4):31-36. DOI:10.20020/j.CNKI.1674-7410.2022.04.07
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1 背景
目前泌尿系结石发病率越来越高,且泌尿系 结石的治疗造成患者经济负担较重[1-3] 。当前外科手 术仍是泌尿系结石治疗的主要手段,包括冲击波 碎 石术 (shock wave lithotripsy,SWL),输尿管 硬/软镜 (ureteroscopy, URS) 和 经 皮 肾 镜 取 石 术 (percutaneous nephrolithotomy,PCNL)。开放 手术取石仅用于病情特殊患者,所占比例较低[4] 。近 几年来随着一次性输尿管软镜、负压吸引软镜鞘、 高功率激光和微型经皮肾通道等技术的应用,泌尿 系结石的手术治疗发生了巨大的变化。随之也出现了 多方面的争议,例如:输尿管镜术后能否不留置支 架管,经皮肾镜碎石术后能否完全“无管化”,直径> 2 cm 的结石能否优先选择输尿管软镜等。2022 年 8 月,欧洲泌尿外科学会 (European Association of Urology,EAU) 更新了尿石症介入治疗的最佳实践 指南 (以下简称指南) [5] ,EAU 对截至到 2021 年 5 月份的新文献数据进行了全面总结和综述,对尿石 症的管理提供了最新的指导,对一些较重要的争议 领域进行了讨论,并为指南的每一项建议提供强度 评级。此外,还指出尿石症诊断治疗期间患者和医 生的辐射暴露应遵循尽可能低的合理可行原则。本 文对指南中更新的内容及临床意义进行总结和解读。
1 背景
2 结石手术围手术期注意事项
2.1 围手术期预防感染
2.2 围手术期抗凝药物管理
3 冲击波碎石相关问题
3.1 留置支架管
3.2 对起搏器或植入除颤器等的影响
3.3 SWL 治疗过程中的注意事项
3.4 对于 SWL 后的辅助治疗
4 输尿管镜相关问题
4.1 输尿管镜激光碎石手术的相关设备
4.2 输尿管支架管的留置
4.3 围手术期是否推荐 MET
4.4 输尿管镜的安全性
4.5 输尿管镜适应证
5 PCNL 相关问题
5.1 PCNL 术前影像学评估
5.2 PCNL 体位的选择
5.3 PCNL 穿刺技术
5.4 PCNL通道的选择
5.5 PCNL 无管化的条件
6 总结与展望
6 总结与展望
从指南的更新可以看出,随着科技的发展,既 往很多外科技术瓶颈已经被攻破,未来将有更加高 效安全的手段来处理泌尿系结石。同时,泌尿外科 医生也要继续探索如何利用新技术来更好地服务患 者,减轻患者痛苦和经济负担。而且,对于有争议 的领域迫切需要高质量证据。
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