復(fù)雜腎結(jié)石的最優(yōu)解決方案適應(yīng)證C.Türk,T.Knoll,A.Petrik,etal.GuidelinesonUrolithiasis.EuropeanAssociationofUrology,2013.適應(yīng)證C.Türk,T.Knoll,A.Petrik,etal.GuidelinesonUrolithiasis.EuropeanAssociationofUrology,2013.適應(yīng)證坎貝爾-沃爾什泌尿外科學(xué)：第9版，1601.適應(yīng)證CAMPBELL-WALSHUrology.TenthEdition,1364.非鹿角形結(jié)石大于2cm，首選PCNL適應(yīng)證CAMPBELL-WALSHUrology.TenthEdition,1373.腎下極結(jié)石大于2cm，首選PCNL適應(yīng)證PNL,followedbyeitherSWLorrepeatedPNL,shouldbeusedformostpatientswithstruvitestaghorncalculi,withPNLbeingtheinitialelementofthecombinationtherapy.鹿角型腎結(jié)石應(yīng)把PCNL作為綜合治療的第一步。CAMPBELL-WALSHUrology.TenthEdition,1365.定位方式C臂機超聲SonixGPS定位方式：超聲優(yōu)點：無輻射提供三維立體信息顯示集合系統(tǒng)、脈管系統(tǒng)及腎臟周圍組織缺點：不直觀需具備超聲知識，經(jīng)過特殊培訓(xùn)需要“人工腎積水”無法明確觀察殘留結(jié)石TzengBC,WangCJ,HuangSW,etal.Dopplerultrasound-guidedpercutaneousnephrolithotomy:aprospectiverandomizedstudy[J].Urology,2011,78(3):535-539.小結(jié)C臂機超聲聯(lián)合應(yīng)用準確定位穿刺通道超微通道（ultra-mini-PCNL）微通道（mini-PCNL）標準通道（standardPCNL）穿刺通道標準通道（standardPCNL）20~24F清石率高并發(fā)癥多穿刺通道微通道（mini-PCNL）14~20F并發(fā)癥少效率低穿刺通道超微通道（ulrta-mini-PCNL）11~13F6Fmini-腎鏡+鈥激光直徑<2cm腎結(jié)石取石效率低灌注壓力大亦可行輸尿管軟鏡或ESWLMPCNL的補充手段DesaiJ,ZengG,ZhaoZ,etal.Anoveltechniqueofultra-mini-percutaneousnephrolithotomy:introductionandaninitialexperiencefortreatmentofupperurinarycalculilessthan2cm[J].BiomedResInt,2013,2013:490793.穿刺通道超微通道（ulrta-mini-PCNL）DesaiJ,ZengG,ZhaoZ,etal.Anoveltechniqueofultra-mini-percutaneousnephrolithotomy:introductionandaninitialexperiencefortreatmentofupperurinarycalculilessthan2cm[J].BiomedResInt,2013,2013:49