局部麻醉下输尿管镜手术的研究进展

Research Progress of Ureteroscopy Surgery under Local Anesthesia

摘要: 局部麻醉下输尿管镜手术在泌尿系结石微创治疗领域呈现出关键的发展状况，此次综述对其进展展开系统回顾，麻醉方案朝着多样化方向发展，主要采用表面麻醉联合镇静的方式，手术器械如输尿管软镜、输尿管通路鞘以及负压吸引系统投入使用，这提升了手术效率，也改善了患者术中体验。其适应症从早期的远端输尿管结石、部分高危病例开始，逐步拓宽至输尿管上段结石以及肾结石，评价体系综合了结石清除率、患者报告结局以及经济效益等方面，证实该手术有恢复较快、费用较低的优势，适合于日间手术模式，然而其临床应用仍面临挑战，包括患者耐受程度存在差异，以及在处理复杂解剖或复杂结石方面存在一定局限性。未来需借助构建标准化管理、精准术前评估以及开展长期研究，明确其临床价值。

Abstract: Ureteroscopic surgery under local anesthesia (URS/FURS) represents a significant advancement in the minimally invasive management of urinary stones. This review systematically summarizes its progress: anesthesia protocols have diversified, with topical anesthesia combined with sedation emerging as the predominant approach; the use of surgical instruments such as flexible ureteroscopes, ureteral access sheaths (UAS), and negative-pressure suction systems has improved both surgical efficiency and intraoperative patient experience; and its indications have gradually expanded from distal ureteral stones and select high-risk cases to include upper ureteral and renal stones. The evaluation framework incorporates stone clearance rates, patient-reported outcomes, and economic benefits, confirming advantages such as rapid recovery and lower cost, making it particularly suitable for ambulatory (day-case) surgery models. However, challenges remain in clinical application, including variable patient tolerance and limitations in managing complex anatomy or complicated stones. Future efforts should focus on establishing standardized protocols, refining preoperative assessment, and conducting long-term studies to further consolidate its clinical value.