Department of Urology, SLK Kliniken, Heilbronn, Germany.
School of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico.
Curr Opin Urol. 2019 Mar;29(2):118-123. doi: 10.1097/MOU.0000000000000574.
To provide a summary of surgical outcomes in percutaneous nephrolithotomy (PCNL) according to various techniques and tract sizes.
Recent literature in this field concluded that standard PCNL (sPCNL) remains the optimal treatment for stones between 1 and 2.5 cm and can be managed with tracts 14-20 F, whereas small stones less than 1.5 cm can be treated with tracts under 14 F. According to new datasets, smaller tracts can be equally effective in the treatment and might offer the possibility to reduce bleeding, length of hospital stay, postoperative pain as well as overall complication rates when compared with sPCNL. On the other hand, longer operative time as well as lower stone-free rates, which have been the main drawbacks of the miniaturized approach, have recently shown to be comparable with sPCNL.
At present, tract size is a highly debatable topic in percutaneous stone therapy. New systems for miniaturized PCNL have been developed to achieve comparable stone-free rates while reducing the incidence of common complications. The adoption of these techniques demands skilled surgeons and institutional investment for the acquisition of new equipment.
根据不同的技术和通道大小，提供经皮肾镜取石术（PCNL）的手术结果总结。
该领域的最新文献得出结论，标准 PCNL（sPCNL）仍然是 1 至 2.5cm 之间结石的最佳治疗方法，可通过 14-20F 通道进行管理，而小于 1.5cm 的小结石可通过小于 14F 的通道进行治疗。根据新数据集，较小的通道在治疗中同样有效，并且与 sPCNL 相比，可能有降低出血、住院时间、术后疼痛和总体并发症发生率的可能性。另一方面，操作时间延长和结石清除率降低一直是微创方法的主要缺点，最近已经表明与 sPCNL 相当。
目前，通道大小是经皮结石治疗中一个极具争议的话题。已经开发了新的微创 PCNL 系统，以在降低常见并发症发生率的同时实现可比的结石清除率。这些技术的采用需要熟练的外科医生和机构投资来获取新设备。
