【科普视频】经皮肾镜取石术(PCNL)

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医生建议患者进行一种肾结石治疗手术，学名“经皮肾镜取石术” 简称PCNL。手术目的是去除所有的肾结石，包括输尿管结石。

本动画展示了肾结石去除的手术过程，患者需在全麻状态下进行经皮肾镜取石术。患者完全进入麻醉状态后，医生会将一中空的导管插入膀胱中，通过膀胱导管将膀胱排空，利用充气球囊将导管固定在适当位置，将另一根导管插入输尿管中，通过这一导管注入对比染色剂，便于观察、确定结石的准确位置，便于找到进入肾脏的位置。同时利用X光或超声波显示出尿道的图像，确定结石位置后，使用一根细针进入肾脏的集合系统，小心地将通道扩张，利用导丝将肾镜安全插入肾脏，部分结石可直接用取石钳取出，大直径的结石需先用激光等设备打碎再将其取出。

结石全部取出后，医生会进行造影对比研究，若造影剂可顺利通过膀胱，说明输尿管中无结石，有些患者还需要植入名为“双J管”的临时支架管，以确保水肿不会阻塞尿液的排出，支架管通过两段的J字形弯曲，在肾脏和膀胱处保持固定位置。

支架管手术结束后，可进行经皮肾造瘘术，肾造瘘管帮助患者进行排尿。导管与支架管在手术后不久即可取出，当患者能够充分排空膀胱且没有发烧或疼痛感时，即可出院。

English Video

Your doctor has recommended that you undergo a stone removal procedure called 'percutaneous nephrolithotomy'or simply PCNL.

The goal of this procedure is to remove all your kidney stones and, when present, ureteral stones.This animation shows the removal of stones in the kidney.PCNL is carried out under general anesthesia.When you are fully sedated,a catheter, which is a hollow tube, is placed in the bladder.The bladder catheter drains the bladder and remains in place with the use of an inflated balloon.Another catheter is placed up into the ureter.Through this catheter, a contrast dye may be instilled  to allow a better view and exact stone location,and to facilitate access to the kidney,while your urinary tract is visualized using x-rays or ultrasound.Once the stone is located,access to the collecting system of your kidney is gained using a thin needle.This access route is carefully dilated.The guide wire allows the nephroscope to safely access the kidney.Some stones can be removed directly using a grasper.Larger stones need to be fragmented first using a device like a laser, before extraction.

After removal of all the stones, your surgeon will perform a contrast study.When there is good passage of contrast material to the bladder,this means that the ureter is also stone-free.In some patients, a temporary small tube called a “double J stent” may be placed to ensure that swelling does not block the drainage of the urine.

The stent remains in place by J-shaped curls in both the kidney and bladder.At the end of the procedure, a nephrostomy may be placed.This catheter helps to drain your urine.The catheters and stent are usually removed shortly after the procedure.You can leave the hospital once you are able to empty your bladder sufficiently,and you have no fever or pain.