2022年AFU白病委员会建议:开放式手术和腹腔镜检查
1Service d'urologie, hôpital Saint-Louis, AP-HP, centre université Paris-Cité, Paris, France.
概括
腹腔镜和机器人手术为复杂的病例提供整个上部泌尿道石头的去除. 虽然在技术上具有挑战性,但这些方法的目的是尽量减少与开放手术相比,功能损失.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 最少侵入性的手术
背景情况:
- 在法国,腹腔镜/机器人手术用于大型 (>20毫米) 和复杂的上尿路结石.
- 这些技术在内镜失败后或同时治疗形时被考虑.
- 关键的优势包括整个石头的去除,而不是碎片化.
研究的目的:
- 在法国的背景下,为腹腔镜/机器人上泌尿道石头去除提供建议.
- 适应现有的欧洲泌尿病学协会 (EAU) 的指导方针.
主要方法:
- 使用临床实践建议 (CPR) 和 ADAPTE 方法开发的建议.
- 考虑欧盟关于尿病的指南 (2022年).
主要成果:
- 解剖学上的挑战包括内骨盆和粘附.
- 并发症包括尿和尿管狭窄,通过双J支架减轻.
- 斯特鲁维特石由于易碎性和潜在的碎片分散而带来挑战.
结论:
- 腹腔镜/机器人手术为复杂的上泌尿道结石提供了替代方案.
- 谨慎的技术和支架是管理风险的关键.
- 传统的开放性手术具有更高的无结石率,但更大的功能损失.
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