孙一鸣 周文生

[摘要] 泌尿系结石是泌尿外科的重要疾病，而肾结石又较为常见，因结石导致的梗阻和感染较易对肾脏功能造成损伤，因此及时且准确的诊治十分重要。近来，随着我国医疗技术的不断发展，经皮肾镜取石术在我国逐渐普及。经皮肾镜取石术（Percutaneous nephrolithotomy，PCNL）是在上世纪80年代由西方国家发明，是通过经皮肾通道结合气压弹道、钬激光或超声碎石设备等对肾盂肾盏或输尿管上段的结石击碎并取出的方法。经皮肾镜取石术手术具有创伤小、患者术后恢复快、手术效果与传统开放手术相当、住院时间短等优点， 已成为治疗肾及输尿管上段结石的第一选择。随着临床上这项技术的开展，通过不断的实践，积累经验，改进技术及更新设备，经皮肾镜取石术取得了很大进展，该技术已成为泌尿系结石手术方式中不可或缺的重要角色。本文现将近来经皮肾镜取石术的发展情况综述如下。

[关键词] 肾结石；经皮肾镜取石术；标准通道；无管化；并发症；研究进展

[中图分类号] R692.4 [文献标识码] A [文章编号] 1673-9701（2018）15-0159-05

The research progress of percutaneous nephrolithotomy

SUN Yiming ZHOU Wensheng

Department of Urology Surgery， the First Affiliated Hospital of Bengbu Medical College， Bengbu 233000， China

[Abstract] Urinary calculi is a kind of important disease in urology， and renal calculi is relatively common. Because the obstructions and infections caused by stones are more likely to cause damage to kidney function， timely and accurate diagnosis and treatment are very important. Recently， with the continuous development of medical technology in China， percutaneous nephrolithotomy has gradually popularized in our country. Percutaneous nephrolithotomy （PCNL） was invented by western countries in the 1980s， by which stones in renal pelvis and calyx or upper ureter are crushed and removed by percutaneous nephrostomy pneumatic lithotripsy， holmium laser or ultrasonic lithotripsy equipment. Percutaneous nephrolithotomy has the advantages of less trauma， rapid postoperative recovery， comparable surgical outcome to traditional open surgery， and short hospital stay. It has become the first choice for treatment of upper ureteral calculi. With the development of this technology in the clinic， great progress has been made in percutaneous nephrolithotomy through continuous practice， accumulating experience， improving technology and updating equipment. This technique has become an indispensable important role in urinary calculi surgery. This article summarizes recent developments in percutaneous nephrolithotomy.

[Key words] Renal calculi； Percutaneous nephrolithotomy； Standard channel； Tubeless； Complication； Research progress

自經皮肾镜取石术问世以来，经过国内外研究人员数十年来不断探索和改进后，在当今泌尿外科治疗泌尿系结石的手术方式中占有重要地位，这种术式相较于传统手术具有创伤小、术后患者恢复快、住院时间短等优点，同时其碎石取石效果亦与传统手术相当，然而其并发症的高危性也使泌尿外科医生和患者困扰和害怕。本文将对经皮肾镜取石术的发展历史、适应证与禁忌证、患者的手术体位选择和结石定位方式、经皮肾穿刺通道的演化、碎石取石方式、术后引流方式、并发症及其处理作一综述，并对经皮肾镜取石术的发展概况作一个简单总结和展望。……