2015结石-1合编.ppt

《 EAU2015版结石诊疗指南》 西安交通大学第一附属医院泌尿外科 陈兴发 Key changes for the 2015 publication In pregnant women, ultrasound is the imaging method of choice. In pregnant women, MRI should be used as a second-line imaging modality. In pregnant women, low-dose CT should be considered as a last-line option. The exposure should be less than 0.05 Gy. If renal stones are not treated, periodic valuation is recommended (after 6 months and yearly thereafter) Radiolucent stones may be dissolvable For ureterolithotomy, laparoscopy is recommended for large impacted stones when endoscopic lithotripsy or SWL has failed. UTIs must be excluded or treated prior to endourologic stone removal. In all patients undergoing endourologic treatment, perioperative antibiotic prophylaxis is recommended. In myelomeningocele patients, latex allergy is common, thus appropriate measures need to be taken regardless of the treatment. For surgical interventions, general anesthesia remains the only option. Horseshoe kidneys Acceptable stone free rates can be achieved with flexible ureteroscopy 肾绞痛的治疗 ?首选双氯芬酸（扶他灵）和消炎痛 ?次选氢吗啡醇、镇痛新和曲蚂多。 ? α受体阻滞剂(坦索罗辛）可降低肾绞痛的复发。 ?对输尿管结石导致肾绞痛急诊SWL可作为一 线治疗。 A combination of alkalinisation with tamsulosin seems to achieve the highest SFRs for distal ureteral stones 结石观察 结石的大小、位置与和患者意愿都是影响和决定是否取石的因素： 新诊断输尿管小于10mm结石不在取石范围的患者，可定期观察，药物排石。 已稳定6个月的无症状肾盏结石，是取石和继续观察仍有争议，当出现结石生长、重新形成梗阻、感染、急或慢性疼痛应治疗。 药物排石治疗 由于文献比较应用a-受体阻滞剂坦索罗辛与钙离子通道拮抗剂硝苯地平治疗远端输尿管结石引起肾绞痛，坦索罗辛更有效缓解肾绞痛，促进输尿管结石排出，推荐使用а-受体阻滞剂药物排石而钙通道拮抗剂不再推荐。 药物排石治疗 由于文献比较应用a-受体阻滞剂坦索罗辛与钙离子通道拮抗剂硝苯地平治疗远端输尿管结石引起肾绞痛，坦索罗辛更有效缓解肾绞痛，促进输尿管结石排出，推荐使用а-受体阻滞剂药物排石而钙通道拮抗剂不再推荐。 a-受体阻滞剂坦索罗辛可减轻留置双J管相关的症状和提高患者耐受性 SWL和URS术后应用a-受体阻滞剂可改善残石清除率。 无管化 Nephrostomy and stents presence of residual stones; likelihood of a second-look procedure; significant intraoperative blood loss; urine extravasation; ureteral obstruction; potential persistent bacteriuria due to infected stones; solitary kidney; bleedi