柔性输尿管镜碎石术治疗上尿路结石的术后并发症：从术前评估到术后管理

doi:10.3969/j.issn.1674-8115.2026.09.013

摘要/Abstract

摘要：

柔性输尿管镜碎石术（flexible ureteroscopic lithotripsy，fURS-L）已成为治疗较小输尿管结石及肾结石（直径≤2 cm）的重要术式；随着内镜技术的不断进步，fURS-L因其微创性、高安全性和可及性，有望成为未来治疗上尿路结石的主要手段。然而，其术后并发症，如感染、输尿管狭窄、输尿管支架相关不适以及更为严重的尿脓毒症等，仍然是临床上面临的重要挑战，制约了其临床疗效提升和临床应用普及。该综述通过整合相关学术文献，阐述近年来fURS-L手术技术和设备创新（如智能压力控制、负压吸引系统和新型激光应用）取得的进展及其对并发症防治的影响，分析其术后并发症的术前风险预测因素（包括患者生理状态、结石负荷及感染状态），并简要论述其术后并发症分类及管理进展。此外，还提出未来的研究方向：制定标准化的术后并发症报告系统；完善基于人工智能和生物标志物的预测模型，实现对高危患者的早期识别和干预；评估一次性柔性输尿管镜的成本效益与环境影响；优化先进技术在复杂病例中的应用策略。

关键词: 柔性输尿管镜碎石术, 上尿路结石, 术前评估, 术后管理

Abstract:

Flexible ureteroscopic lithotripsy (fURS-L) has become the important surgical technique for the treatment of small ureteral and renal calculi with a diameter of ≤2 cm. With the continuous advancement of endoscopic techniques, fURS-L is expected to emerge as the primary modality for upper urinary tract calculi management in the future due to its minimal invasiveness, high safety, and accessibility. Nevertheless, its postoperative complications, such as infection, ureteral stricture, stent-related discomfort, and more severe urosepsis, remain major clinical challenges that restrict improvements in its therapeutic efficacy and hinder its widespread clinical application. This review integrates relevant academic literature to elaborate on recent advances in surgical techniques and equipment innovations of fURS-L (including intelligent pressure control, negative-pressure suction systems, and novel laser applications) and their impacts on the prevention and management of complications. It analyzes preoperative risk predictors of postoperative complications, which encompass patients′ physical conditions, stone burden, and infectious status, and briefly discusses the classification and updated management strategies of postoperative complications. Furthermore, future research directions are proposed, including establishing a standardized reporting system for postoperative complications, refining prediction models based on artificial intelligence and biomarkers to enable early identification and intervention for high-risk patients, evaluating the cost-effectiveness and environmental impacts of disposable flexible ureteroscopes, and optimizing application strategies of advanced technologies in complex clinical cases.

Key words: flexible ureteroscopic lithotripsy (fURS-L), upper urinary tract calculi, preoperative assessment, postoperative management

中图分类号:

R693⁺.4

刘俊辰, 刘敏. 柔性输尿管镜碎石术治疗上尿路结石的术后并发症：从术前评估到术后管理[J]. 上海交通大学学报（医学版）, 2026, 46(9): 1283-1289.

Liu Junchen, Liu Min. Postoperative complications in the treatment of upper urinary tract stones with flexible ureteroscopic lithotripsy: from preoperative assessment to postoperative management[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026,(9): 1283-1289.

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