≤2 cm上尿路结石术后无管化的研究进展

Research Progress on Postoperative Tubeless Management for Upper Urinary Tract Stones ≤ 2 cm

摘要: 目的：术后引流管留置曾是上尿路结石微创手术的“标准配置”——肾造瘘管与输尿管支架管被视为保障术后引流、预防并发症的“安全网”。然而，随着加速康复外科理念的深入和手术技术的精细化，这一传统正被逐步打破。无管化(tubeless)技术，即在经皮肾镜取石术(PCNL)或输尿管镜碎石术(URS)后选择性省略肾造瘘管和/或输尿管支架，已成为≤2 cm上尿路结石治疗领域的重要发展方向。大量循证医学证据表明，在严格筛选的患者中，无管化手术可显著减轻术后疼痛、缩短住院时间、加速康复，且不增加并发症风险。2025年EAU指南已将其纳入推荐。本文系统综述≤2 cm上尿路结石术后无管化的定义与分类、适应证、临床证据、技术要点、并发症及未来方向，以期为临床实践和后续研究提供参考。

Abstract: Objective: Postoperative drainage has long been considered a “standard configuration” following minimally invasive surgery for upper urinary tract stones—with nephrostomy tubes and ureteral stents serving as a “safety net” to ensure adequate drainage and prevent complications. However, with the deepening adoption of Enhanced Recovery after Surgery (ERAS) principles and refine-ments in surgical techniques, this tradition is being progressively challenged. Tubeless techniques, defined as the selective omission of nephrostomy tubes and/or ureteral stents after percutaneous nephrolithotomy (PCNL) or ureteroscopy (URS), have emerged as a significant trend in the man-agement of upper urinary tract stones ≤ 2 cm. A growing body of evidence-based medical data indi-cates that, in strictly selected patients, tubeless procedures significantly reduce postoperative pain, shorten hospital stays, accelerate recovery, and do not increase the risk of complications. The 2025 European Association of Urology (EAU) Guidelines have formally incorporated this approach into their recommendations. This article provides a systematic review of the definition, classification, indications, clinical evidence, technical essentials, complications, and future directions of postoper-ative tubeless management for upper urinary tract stones ≤ 2 cm, aiming to offer guidance for clin-ical practice and future research.