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非手术方法取出上尿路结石,是泌尿外科医生多年来梦寐以求的事情。膀胱结石的内窥镜治疗成为腔内泌尿外科技术的先导,但对于肾盂和输尿管上段的结石却仍然是望“石”莫及。近年来 X 线透视和超声波的联合应用,使无积水的肾脏经皮穿刺造瘘获得成功,并经造瘘口以软性(纤维)或硬性(金属)肾盂输尿管镜取出上尿路结石。至此,所谓经皮肾穿刺造瘘取石术(percutaneous nephro—ureterolithoto-my,PNL)迅速发展起来。一适应证和禁忌证适应证:PNL 适用于各种类型不能自然排出的肾盂和输尿管上段结石,手术指征与外科开放手术基本相同。禁忌证:出血素质,无症状的肾盏小结石(直径<4.0mm),第五腰椎以下的输尿管下段结石,脊柱过度后弯和严重的尿路感染。
Non-surgical removal of the upper urinary tract stones is what urologists have been dreaming for years. Endoscopic treatment of bladder stones to become the leading endourology, but for the upper pelvis and ureter stones is still hopeless. In recent years, the combined application of fluoroscopy and ultrasound, so that non-hydrostatic renal percutaneous puncture fistula was successful, and the fistula with soft (fibrous) or rigid (metal) ureteroscopic ureteral removal of upper urinary calculi. So far, the so-called percutaneous nephro-ureterolithoto-my (PNL) rapid development. Indications and contraindications Indications: PNL applies to all types of renal pelvis and ureter stones that can not be excreted spontaneously, and surgical indications are essentially the same as for open surgical procedures. Contraindications: bleeding quality, asymptomatic small calyceal calyx (diameter <4.0mm), the lower part of the fifth lumbar lower ureteral calculi, excessive posterior curvature of the spine and severe urinary tract infections.