[肾结石的管理]
[Management of renal stones].
作者信息
Lechevallier E, Traxer O, Saussine C
机构信息
Service d'urologie, hôpital de La-Conception, 147, boulevard Baille, 13005 Marseille, France.
出版信息
Prog Urol. 2008 Dec;18(12):959-62. doi: 10.1016/j.purol.2008.09.024. Epub 2008 Oct 16.
The management of renal stones needs a recent and good quality imaging. Contrast medium injection is optional. Extracorporeal shockwave lithotripsy (ESWL) is the most common treatment of renal stones. ESWL is indicated as first line treatment for less than 1.5cm stones. The stone-free (SF) rate at 3 months of ESWL is 70-80%. Results of ESWL for stones with more than 1000UH density or located in the lower calyx are poor. Flexible ureteroscopy (URS) is indicated in case of ESWL failure or for hyperdense, 1-2cm stones. The SF rate of flexible is 80%. Percutaneous nephrolithotomy is indicated for complex or more than 2cm stones. Asymptomatic and non infected stones, especially if located in the lower calyx, do not need urological treatment but must be followed up. In all cases, renal stones needs a metabolic evaluation and treatment, and annual follow-up.
肾结石的治疗需要近期高质量的影像学检查。是否注射造影剂可选择。体外冲击波碎石术（ESWL）是肾结石最常见的治疗方法。ESWL被指定为直径小于1.5厘米结石的一线治疗方法。ESWL术后3个月的结石清除率为70-80%。对于密度超过1000UH或位于下盏的结石，ESWL的效果较差。如果ESWL失败或结石密度高、直径1-2厘米，则适合采用软性输尿管镜检查（URS）。软性输尿管镜检查的结石清除率为80%。经皮肾镜取石术适用于复杂结石或直径超过2厘米的结石。无症状且未感染的结石，尤其是位于下盏的结石，无需泌尿外科治疗，但必须进行随访。在所有情况下，肾结石都需要进行代谢评估和治疗，并每年进行随访。
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