泌尿系结石外科治疗研究现状及进展

Research Status and Progress in Surgical Treatment of Urinary Tract Stone

摘要: 泌尿系结石是泌尿系统疾病中常见的一种，世界不同地区的发病率在5%~10%之间，趋势逐年上升。由于结石成分、大小、位置和患者具体情况的多样性，其外科治疗方法也不断地发展与完善。本文综述了泌尿系结石外科治疗的研究现状及进展。首先，对泌尿系结石的成因、分类和临床表现进行了简要说明，并描述了结石诊断的主要手段。随后分别介绍了常用的外科治疗方法：经皮肾镜碎石术(PCNL)、输尿管镜碎石术(URS)、冲击波碎石术(ESWL)和腹腔镜以及机器人辅助手术。每种治疗方式的优缺点、适应症和技术进展均有重点阐述。其间，对最新的微创治疗技术如微通道PCNL、经皮内镜下激光碎石及输尿管内镜下联合应用超声和激光碎石等进展做了详细介绍。文献综述还涉及了结石的再治疗策略、术后管理和预防复发的相关研究，以及患者生活质量的评估。此外，对未来泌尿系结石外科治疗可能的发展方向，包括新兴的碎石技术、减少术中X线暴露的方法、药物辅助治疗以及结石病理研究都进行了探讨。

Abstract: Urinary calculi are a common type of urological disease, with an incidence rate ranging between 5% and 10% in different regions of the world, and the trend is increasing year by year. Due to the diversity in the composition, size, location, and specific conditions of the patients, surgical treatment methods for calculi continuously evolve and improve. This article reviews the current status and progress of surgical treatment for urinary calculi. Initially, a brief explanation of the etiology, classification, and clinical manifestations of urinary calculi is provided, as well as a description of the main diagnostic methods for calculi. Subsequently, the commonly used surgical treatment methods: percutaneous nephrolithotomy (PCNL), ureteroscopy (URS), extracorporeal shock wave lithotripsy (ESWL), and laparoscopic and robotic-assisted surgery are introduced respectively. The advantages and disadvantages, indications, and technical advancements of each treatment modality are highlighted. In the process, detailed introductions are given to the latest minimally invasive treatment technologies such as microchannel PCNL, percutaneous endoscopic laser lithotripsy, and ureteroscopic combination of ultrasound and laser lithotripsy. The literature review also covers issues related to the retreatment strategy for calculi, postoperative management, prevention of recurrence, and the evaluation of patient quality of life. Additionally, the article discusses potential future directions for surgical treatment of urinary calculi, including emerging lithotripsy technologies, methods to reduce intraoperative X-ray exposure, adjunct pharmacological treatments, and pathological research on calculi. Studies indicate that the selection of individualized treatment plans is crucial for improving therapeutic effectiveness, reducing complications, and recurrence rates.