基于解剖学特征的肾下盏结石个体化诊疗策略研究进展

Progress in Research on Individualized Diagnosis and Treatment Strategies for Lower Calyx Kidney Stones Based on Anatomical Features

摘要: 肾下盏结石因其解剖位置特殊(肾下盏漏斗部与肾盂夹角小、尿液引流不畅)，临床治疗存在争议。随着影像学技术如计算机断层扫描尿路成像(Computed Tomography Urography, CTU)、三维超声及微创手术器械的进步，其诊断与治疗策略近年取得显著进展。本文综述肾下盏结石的流行病学特征、病因机制、诊断技术及治疗策略，重点探讨手术方式选择(体外冲击波碎石术、经皮肾镜取石术、输尿管软镜手术)的适应证与疗效差异。流行病学显示，肾下盏结石占肾结石的35%~40%，其形成与代谢综合征、糖尿病及肥胖密切相关。诊断方面，CT尿路成像已成为金标准，而人工智能辅助诊断系统可提高结石检出率。治疗策略需结合结石负荷、解剖特点及患者全身状况：体外冲击波碎石术适用于直径 ≤ 2 cm结石，但清除率受解剖参数影响；经皮肾镜取石术对复杂结石清除率高，但并发症风险需关注；输尿管软镜手术在≤3 cm结石中住院时间更短。未来需进一步探索个体化治疗算法，并纳入基因多态性、尿液代谢组学等生物标志物优化决策。本研究为临床医师提供基于循证医学的诊疗参考，推动肾下盏结石管理向精准化发展。

Abstract: Lower calyx kidney stones pose clinical treatment challenges due to their specific anatomical location (narrow infundibulum-pelvic angle and poor urine drainage). With advancements in imaging technologies such as Computed Tomography Urography (CTU), three-dimensional ultrasonography, and minimally invasive surgical instruments, significant progress has been made in the diagnosis and treatment strategies in recent years. This paper reviews the epidemiological characteristics, etiological mechanisms, diagnostic techniques, and treatment strategies for lower calyx kidney stones, with a focus on the selection of surgical methods (extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy, and ureteroscopic surgery) and the differences in their indications and efficacy. Epidemiological data show that lower calyx stones account for 35%~40% of kidney stones, and their formation is closely associated with metabolic syndrome, diabetes, and obesity. In terms of diagnosis, CTU has become the gold standard, while AI-assisted diagnostic systems can improve stone detection rates. Treatment strategies should consider stone burden, anatomical characteristics, and overall patient condition: Extracorporeal shock wave lithotripsy is suitable for stones ≤ 2 cm in diameter, although clearance rates are influenced by anatomical parameters; percutaneous nephrolithotomy has a high clearance rate for complex stones but carries a risk of complications; ureteroscopic surgery offers shorter hospitalization for stones ≤ 3 cm. Future research should further explore individualized treatment algorithms and incorporate biomarkers such as genetic polymorphisms and urinary metabolomics to optimize decision-making. This study provides clinical physicians with evidence-based diagnostic and treatment references and promotes precision management of lower calyx kidney stones.