复杂性泌尿系结石治疗新方法：针状肾镜辅助内镜手术

New treatment methods for complex urinary stones: Needle-perc assisted endoscopic surgery

摘要

复杂性泌尿系结石一直是临床治疗的重点与难点。传统的多通道经皮肾镜碎石术（PCNL）处理多发或大体积肾结石具有较高的净石率及效率，但同样存在严重并发症发生的风险。输尿管软镜碎石术（RIRS）具有创伤小、恢复快等特点，是治疗＜2 cm肾结石的首选，但对于解剖不良的肾小盏结石、小肾盂肾下盏漏斗夹角（IPA）的肾下盏结石以及复杂性肾盏憩室结石等问题处理困难。针状肾镜（Needle-perc）辅助内镜手术（NAES）主要包含2种模式：①Needle-perc联合传统标准通道PCNL（SPCNL），在保证较高净石率的前提下可有效减少通道数量、降低手术风险并保护肾脏功能；②Needle-perc联合RIRS，在不增加肾脏损伤的前提下可明显提高手术成功率和净石率。NAES手术在处理复杂泌尿系结石方面具有显著优势。为了更好地普及和推广该技术，本文结合国内外相关文献及本中心的临床应用经验，重点介绍NAES手术的适应证、使用规范、具体操作技巧及注意事项等内容。

Abstract

Complex urinary stones have been the focus and difficulty of clinical treatment. Traditional multi-channel percutaneous nephrolithotomy (PCNL) has a high stone-free rate and efficacy in the treatment of multiple or large volume kidney stones, but has risk of serious complications such as bleeding and injury. Retrograde intrarenal surgery (RIRS) has been preferred in the treatment of renal stones with a diameter of less than 2 cm due to its characteristics of small trauma and fast recovery. However, it is difficult to treat small calyx stones with poor anatomy, lower renal calyx stones with small IPA, and diverticulum stones. Needle-perc assisted endoscopic surgery (NAES) includes the following modes: ① Needle-perc plus PCNL, which can effectively reduce the number of channels, reduce surgical risks, and protect kidney function while ensuring a high stone-free rate; ② Needle-perc plus RIRS, which can significantly improve the success rate and stone-free rate without increasing kidney damage, thus having significant advantages in dealing with complex urinary stones. In order to popularize and promote this technique, this essay will review the relevant domestic and foreign literature and the clinical experience of our center, focusing on the indications, usage specifications, operative skills and precautions of NAES.

关键词

复杂性泌尿系结石 / 针状肾镜 / 针状肾镜辅助内镜手术 / 经皮肾镜碎石术 / 输尿管软镜碎石术

Key words

complex urinary stones / Needle-perc / Needle-perc assisted endoscopic surgery / percutaneous nephrolithotomy / retrograde intrarenal surgery

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