Alivizatos Gerasimos, Skolarikos Andreas
Second Department of Urology, Athens Medical School, Sismanoglio Hospital, Athens, Greece.
Curr Opin Urol. 2006 Mar;16(2):106-11. doi: 10.1097/01.mou.0000193379.08857.e7.
In the last few decades, with the improvement in endourological surgery and the invention and evolution of extracorporeal shock-wave lithotripsy, the indications for open surgery in stone disease have become rare, although open surgery still has a role in selected cases. In this review we discuss the current indications of open surgery for the elimination of urinary calculi.
A MEDLINE and MeSH search was performed to evaluate currently available guidelines on open stone surgery and identify the evidence-based medicine that support the role of open surgery in treating urinary lithiasis. The latest papers published on open stone surgery are reviewed and conclusions are drawn, based on their results.
Open stone surgery should be avoided in most cases, but should be considered for those patients in whom a reasonable number of less invasive procedures would not be useful. The most common indications for open stone surgery include complex stone burden, failure of extracorporeal shock-wave lithotripsy or endourological treatment and anatomical abnormalities (such as ureteropelvic junction obstruction and infundibular stenosis with or without renal caliceal diverticulum). The level of evidence for the currently available guidelines is not adequate, mainly because of lack of properly designed, large prospective randomized trials that compare different treatment options.
在过去几十年中，随着腔内泌尿外科手术的进步以及体外冲击波碎石术的发明与发展，结石病开放手术的适应证已变得罕见，尽管开放手术在某些特定病例中仍有作用。在本综述中，我们讨论了开放手术治疗尿路结石的当前适应证。
进行了MEDLINE和医学主题词（MeSH）检索，以评估当前可用的开放结石手术指南，并确定支持开放手术在治疗尿路结石中作用的循证医学依据。对发表的关于开放结石手术的最新论文进行了综述，并根据其结果得出结论。
在大多数情况下应避免开放结石手术，但对于那些进行合理数量的侵入性较小的手术无效的患者应予以考虑。开放结石手术最常见的适应证包括复杂的结石负荷、体外冲击波碎石术或腔内泌尿外科治疗失败以及解剖异常（如肾盂输尿管连接部梗阻和漏斗部狭窄伴或不伴肾盏憩室）。目前可用指南的证据水平不足，主要是因为缺乏设计合理、大型的前瞻性随机试验来比较不同的治疗选择。
