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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/11/28 23:52:31」(JST)

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Percutaneous nephrolithotomy (PCNL) is a minimally-invasive procedure to remove stones from the kidney by a small puncture wound (up to about 1 cm) through the skin. It is most suitable to remove stones of more than 2 cm in size and which are present near the pelvic region. It is usually done under general anesthesia or spinal anesthesia.

Procedure

A retrograde pyelogram is done to locate the stone in the kidney. With a small 1 centimeter incision in the loin, the percutaneous nephrolithotomy (PCN) needle is passed into the pelvis of the kidney. The position of the needle is confirmed by fluoroscopy. A guide wire is passed through the needle into the pelvis. The needle is then withdrawn with the guide wire still inside the pelvis. Over the guide wire the dilators are passed and a working sheath is introduced. A nephroscope is then passed inside and small stones taken out. In case the stone is big it may first have to be crushed using ultrasound probes and then the stone fragments removed.^[1]

The most difficult portion of the procedure is creating the tract between the kidney and the flank skin. Most of the time this is achieved by advancing a needle from the flank skin into the kidney, known as the 'antegrade' technique. A 'retrograde' technique has recently been updated wherein a thin wire is passed from inside the kidney to outside the flank with the aid of a flexible ureteroscope. This technique may reduce radiation exposure for patient and surgeon. ^[2]

Complications

The following complications^[1] may take place:

Injury to the colon
Injury to the renal blood vessels
Urinary leak may persist for a few days
Infection and sepsis
Hydrothorax if PCNL is done through 11th intercostal space
Bleeding
Death

Notes and references

^ ^a ^b Dr.Rajgopal Shenoy K (2006). Manipal Manual of Surgery - Second Edition, p.619. CBS Publishers & Distributors, New Delhi.
^ Flexible ureteroscopy-directed retrograde nephrostomy for percutaneous nephrolithotomy: description of a technique. Wynberg JB et al. J of Endourol. 2012 Oct;26(10):1268-74

A Novel 5-Part Percutaneous Access Needle With Glidewire Technique (5-PANG) for Percutaneous Nephrolithotomy: Our Initial Experience Ashish V. Patil Urology - May 2010 (Vol. 75, Issue 5, Pages 1206-1208, doi:10.1016/j.urology.2009.11.027)

UpToDate Contents

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1. 成人における腎尿管結石症マネージメントのオプション options in the management of renal and ureteral stones in adults
2. ストルバイト結石およびサンゴ状結石のマネージメント management of struvite or staghorn calculi
3. 尿管結石のマネージメント management of ureteral calculi
4. 尿管ステントの留置およびマネージメント placement and management of indwelling ureteral stents
5. 体外衝撃波砕石術の腎合併症 renal complications of extracorporeal shock wave lithotripsy

English Journal

Re: Percutaneous Nephrolithotomy Versus Retrograde Intrarenal Surgery: A Systematic Review and Meta-analysis.

Kallidonis P1, Liatsikos E2.
European urology.Eur Urol.2015 Oct;68(4):740-1. doi: 10.1016/j.eururo.2015.06.036.
PMID 26334124

EAU Guidelines on Interventional Treatment for Urolithiasis.

Türk C1, Petřík A2, Sarica K3, Seitz C4, Skolarikos A5, Straub M6, Knoll T7.
European urology.Eur Urol.2015 Sep 3. pii: S0302-2838(15)00700-9. doi: 10.1016/j.eururo.2015.07.041. [Epub ahead of print]
CONTEXT: Management of urinary stones is a major issue for most urologists. Treatment modalities are minimally invasive and include extracorporeal shockwave lithotripsy (SWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PNL). Technological advances and changing treatment patterns have had
PMID 26344917

Japanese Journal

周術期の抗血栓療法をヘパリンに置換した手術症例の検討

松岡崇志,井上幸治,水野桂 [他],北悠希,仲西昌太郎,浅井聖史,田岡利宜也,宗田武,寺井章人
泌尿器科紀要 58(5), 223-226, 2012-05-00
… We compared 51 cases of transurethral resection of bladder tumor, transurethral resection of the prostate holium laser enucleation of the prostate, nephroureterectomy and percutaneous nephrolithotomy with heparinization were compared to 692 cases with no heparinization. …
NAID 40019283461

腹腔鏡下腎盂切石術を施行した馬蹄腎の1例

佐々木有見子,柑本康夫,西澤哲 [他],吉川和朗,南方良仁,松村永秀,稲垣武,原勲
泌尿器科紀要 58(2), 87-91, 2012-02-00
… Percutaneous nephrolithotomy was also difficult due to malrotation of the pelvic-caliceal system and possible interposition of bowel loops between kidney and abdominal wall. …
NAID 40019169071