復雜性泌尿系結石治療新方法：針狀腎鏡輔助內鏡手術（“大家泌尿網”觀看手術視頻）

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

LIU Yubao，LI Jianxing

（Department of Urology，Beijing Tsinghua Changgung Hospital，School of Clinical Medicine，Tsinghua University，Beijing 102218，China）

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：①Needle-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; ②Needle-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.

KEY WORDS：complex urinary stones; Needle-perc; Needle-perc assisted endoscopic surgery; percutaneous nephrolithotomy; retrograde intrarenal surgery

摘要：復雜性泌尿系結石一直是臨床治療的重點與難點。傳統的多通道經皮腎鏡碎石術（PCNL）處理多發或大體積腎結石具有較高的凈石率及效率，但同樣存在嚴重并發癥發生的風險。輸尿管軟鏡碎石術（RIRS）具有創傷小、恢復快等特點，是治療＜2 cm腎結石的首選，但對于解剖不良的腎小盞結石、小腎盂腎下盞漏斗夾角（IPA）的腎下盞結石以及復雜性腎盞憩室結石等問題處理困難。針狀腎鏡（Needle-perc）輔助內鏡手術（NAES）主要包含2種模式：①Needle-perc聯合傳統標準通道PCNL（SPCNL），在保證較高凈石率的前提下可有效減少通道數量、降低手術風險并保護腎臟功能；②Needle-perc聯合RIRS，在不增加腎臟損傷的前提下可明顯提高手術成功率和凈石率。NAES手術在處理復雜泌尿系結石方面具有顯著優勢。為了更好地普及和推廣該技術，本文結合國內外相關文獻及本中心的臨床應用經驗，重點介紹NAES手術的適應證、使用規范、具體操作技巧及注意事項等內容。

關鍵詞：復雜性泌尿系結石；針狀腎鏡；針狀腎鏡輔助內鏡手術；經皮腎鏡碎石術；輸尿管軟鏡碎石術

中圖分類號：R692.4 文獻標志碼：ADOI：10.3969/j.issn.1009-8291.2025.02.001

收稿日期：2024-07-01 修回日期：2024-11-21

通信作者：李建興，主任醫師。E-mail：ljx1@sina.com

作者簡介：劉宇保，副主任醫師。研究方向：泌尿系結石的微創治療及醫工交叉研究。E-mail：Justin77337733@sina.com

泌尿系結石是泌尿外科的常見病和多發病，一直是臨床診療的重點。我國的結石整體發病率約為1%～5%，南方高達5%～10%。其中25%的患者需要外科治療^［1］。隨著人民生活質量的提高和飲食習慣的改變，近幾年我國結石發病率有增長趨勢且復發率較高，最新調查顯示約1/17的成年人患有腎結石^［2］。……