Complex and difficult kidney stones include stones larger than 2.0 cm in diameter, antler-shaped stones, multiple stones, ectopic kidney stones, combined horseshoe kidney stones, infected stones, cystine stones, isolated kidney stones, etc. These are large stones or special stones that cannot be solved by extracorporeal lithotripsy machines, and are also the most likely to recur, and patients often need multiple surgical interventions during their lifetime, and in the past a patient was operated on several times to retrieve stones In the past, multiple surgical interventions for a patient were common, which seriously affected the physical and mental health of patients. Currently, for these complex and difficult stones, minimally invasive treatment is promoted through percutaneous nephrological, ureteroscopic and other lumpectomy techniques. The specific procedure of PCNL is as follows: firstly, the doctor sets the position on the patient and uses a slim puncture needle to puncture directly into the kidney from the back and gradually expand to establish a percutaneous nephrostomy channel, the diameter of this channel puncture opening is only 5-6mm; secondly, advanced intracavitary lithotripsy instruments (such as pneumatic ballistic, laser) are used to break the stones in the patient’s kidney through endoscopic observation and turn them into Then, the stones are removed one by one through the percutaneous nephrostomy channel with stone extraction forceps and other methods. After the surgery, only a tiny wound is left on the patient’s body, which is almost scarless after healing. This procedure is compared to a “hole in the wall” procedure. Percutaneous nephrolithoscopy technique is mainly used to treat difficult giant kidney stones, multiple kidney stones and upper ureteral stones. Q: What is percutaneous nephrolithotomy for stone extraction? A: Complex and difficult kidney stones include stones larger than 2.0 cm in diameter, antler-shaped stones, multiple stones, ectopic kidney stones, combined horseshoe kidney stones, infected stones, cystine stones, isolated kidney stones, etc. These are large stones or special stones that cannot be solved by extracorporeal lithotripsy machines, and are also the most recurrent stones, which often require multiple surgical interventions during the patient’s lifetime, and multiple openings for one patient in the past Stone extraction, which is common, has seriously affected the physical and mental health of patients. Currently, minimally invasive treatment through percutaneous nephrolithoscopy, ureteroscopy and other lumpectomy techniques are promoted for these complex and difficult stones. Percutaneous nephrolithoscopy technology is to make a pen-sized hole in the patient’s waist to establish a channel from the skin to the kidney, and then use laser or pneumatic ballistic combined with ultrasonic lithotripsy under the nephrolithoscope to break up the stones and suck them out of the body, which is imaginatively compared to “making a hole to get a stone”. Percutaneous nephrolithotomy is mainly used to treat difficult giant kidney stones, multiple kidney stones and upper ureteral stones. Percutaneous nephrolithotomy is a new technique for the treatment of urinary stones that has emerged in recent years. It is performed through percutaneous nephrostomy using a special endoscope and intracavitary lithotripsy and lithotripsy equipment. As early as the 10th century AD, there was a legend of kidney stone extraction through skin poking holes in Arabia, but the success rate was low due to the limitation of conditions, so it has not been promoted. It was only after the introduction of percutaneous nephrolithoscopy in the mid-1970s that this technique was perfected and was applied. In China, this technique and equipment were introduced from abroad in the early 1980s, and were first successful in Beijing and Guangzhou, and then pushed to the whole country. Because the equipment required for percutaneous nephrolithotomy is more expensive and the technical requirements are higher, only some large and medium-sized hospitals in China are currently carrying out this technique. There are two types of percutaneous nephrolithoscopes: rigid nephrolithoscope and more rigid nephrolithoscope. The smaller nephroscope, with a front end that can be turned as needed, allows easy access to the calyces, but the operating hole is small and is only used to treat small stones that can be removed intact with an indwelling nephrostomy. The rigid nephroscope is thicker and has a large orifice through which various intracavitary lithotripsy and lithotripsy instruments can be inserted, and is the most commonly used instrument for percutaneous nephrolithotripsy. Percutaneous nephrolithotomy is usually performed under anesthesia. The renal pelvis is punctured under X-ray or ultrasound guidance, and then the puncture channel is dilated to the desired size, through which a nephrolithoscope is inserted and the stone is removed under visualization or broken up with special lithotripsy equipment. The first step in the success or failure of the procedure is the creation of a channel from the skin to the renal pelvis, known as a renal puncture fistula, and a renal pelvic puncture fistula. Renal pelvis puncture is usually performed at the same time as stone extraction, or the fistula can be punctured earlier and the percutaneous nephrolithotomy can be performed after the sinus tract is formed, which usually takes about 2 weeks. The advantage of simultaneous puncture is that the operation is completed in one visit and the hospital stay is short; the disadvantage is that the operation may be affected by bleeding and other reasons, increasing the chance of failure. The disadvantage of early fistula and then secondary surgery is the long hospital stay and the need for two surgical operations, but the sinus tract formation results in less intraoperative bleeding, clear vision, and high surgical success rate. Percutaneous nephrolithoscopy can treat stones in the renal pelvis, calyces and upper ureter. In general, stones located in the renal pelvis and the punctured calyces are easier to remove or break up. Stones in the other calyces, especially when the calyces are small, are less likely to be removed or fragmented. Stones in the upper ureter require a combination of ureteroscopy, i.e., parallelepipedal ureteroscopy for stone extraction. Percutaneous nephrolithoscopy can treat stones as well as pelvic ureteral junction stenosis and upper ureteral stenosis. A nephrostomy tube is routinely left in place after percutaneous nephrolithotomy. The advantages of percutaneous nephrolithotomy are obvious as it can treat kidney and upper ureteral stones through a channel of less than 1 cm in diameter, which is less damaging than conventional surgical treatment, less percussion, and faster postoperative recovery. The puncture expansion of percutaneous nephrostomy can also cause some renal parenchymal damage, so there are also many disadvantages. With the popularization of extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy is gradually being replaced in places where lithotripsy is available. At present, it is mainly used as an adjuvant treatment before and after extracorporeal shock wave lithotripsy, but not as the main treatment method.