经皮肾镜碎石取石术穿刺定位技术的研究进展

doi:10.3877/cma.j.issn.1674-3253.2026.05.016

目的

经皮肾镜碎石取石术（PCNL）是治疗大体积肾结石（>2 cm）的主要方法，穿刺定位是手术成功的关键。本文梳理了PCNL穿刺定位技术的研究进展，旨在为提升PCNL手术技能提供策略。

方法

系统检索PubMed、Web of Science、中国知网等数据库相关文献，综合分析传统（X线、超声、CT引导）及新型（增强现实、电磁跟踪、机器人辅助、三维可视化）定位技术的原理、优势、局限性及临床应用价值。

结果

以机器人辅助、增强现实、CT-超声融合、电磁跟踪等为代表的新型影像引导技术，在提高定位准确性、降低手术难度、缩短学习曲线和减少辐射暴露方面展现出显著优势。

结论

立体成像技术、辐射剂量控制、图像质量优化及多模态图像融合是PCNL穿刺定位技术发展的关键方向。人工智能与医学影像技术的融合，有望进一步缩短学习曲线、降低手术难度，对PCNL技术的普及推广具有重要意义。

关键词: 经皮肾镜碎石取石术, 影像导航, 增强现实, 超声-CT融合, 机器人手术, 三维可视化

Objective

Percutaneous nephrolithotomy (PCNL) is the main treatment for large renal calculi (>2 cm), and puncture localization is the key to surgical success. This article reviews the research progress of puncture localization techniques in PCNL to provide strategies for improving PCNL surgical skills.

Methods

A systematic literature search was conducted across databases including PubMed, Web of Science, and CNKI. The principles, advantages, limitations, and clinical utility of both conventional (fluoroscopy, ultrasound, CT-guidance) and emerging (augmented reality, electromagnetic tracking, robotic assistance, three-dimensional visualization) localization techniques were analyzed.

Results

Novel imaging-guided techniques, such as robot-assisted, augmented reality, CT-ultrasound fusion, and electromagnetic tracking, have shown significant advantages in improving localization accuracy, reducing surgical difficulty, shortening the learning curve, and decreasing radiation exposure.

Conclusion

Key future directions include stereoscopic imaging, radiation dose reduction, image quality optimization, and multimodal image fusion. The integration of artificial intelligence with medical imaging technologies holds promise for further shortening the learning curve and reducing procedural complexity, which is crucial for the broader adoption of PCNL.

Key words: Percutaneous nephrolithotomy, Image-guided navigation, Augmented reality, CT-ultrasound-fusion, Robot-assisted surgery, Three-dimensional visualization

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Advances in puncture localization techniques for percutaneous nephrolithotomy

模态框（Modal）标题

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Advances in puncture localization techniques for percutaneous nephrolithotomy