Ganpule Arvind P, Desai Mahesh
Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.
Curr Opin Urol. 2008 Mar;18(2):220-3. doi: 10.1097/MOU.0b013e3282f3e6e4.
Complete removal of stones is crucial for preventing recurrence and morbidity. Currently percutaneous nephrolithotomy is the preferred treatment modality. The debate continues over the use of single tract versus multiple tract percutaneous nephrolithotomy. We review papers on the topic published over the past 12-24 months.
Articles related to single and multiple tracts were reviewed. We discuss the morbidities, advantages and disadvantages of both the approaches. To decrease the number of tracts few authors have shown the efficacy of flexible ureteroscopy and nephroscopy as an adjuvant procedure. The authors state that this option effectively decreases the disadvantages of multiple tracts, namely blood loss complications, without compromising on stone free rates.
Several techniques have been described for percutaneous access and stone removal, all of them associated with inherent problems. Although feasible, access to all the calices will be difficult through one percutaneous tract because of the peculiarities of the renal collecting system, in which case, multiple-access percutaneous nephrolithotomy is the mainstay of the treatment. The crucial point to understand is that all cases should be dealt with on an individual basis.
结石的完全清除对于预防复发和发病至关重要。目前，经皮肾镜取石术是首选的治疗方式。关于单通道与多通道经皮肾镜取石术的使用仍存在争议。我们回顾了过去12至24个月发表的关于该主题的论文。
对与单通道和多通道相关的文章进行了回顾。我们讨论了两种方法的发病率、优点和缺点。为了减少通道数量，少数作者展示了软性输尿管镜和肾镜作为辅助手术的有效性。作者指出，这种选择有效地减少了多通道的缺点，即失血并发症，同时不影响结石清除率。
已经描述了几种经皮穿刺和结石清除技术，所有这些技术都存在固有问题。尽管可行，但由于肾集合系统的特殊性，通过一个经皮通道进入所有肾盏将很困难，在这种情况下，多通道经皮肾镜取石术是主要的治疗方法。需要理解的关键点是，所有病例都应根据个体情况进行处理。
