目的探讨微创经皮肾输尿管镜取石术(MPCNL)在治疗上尿路结石的有效性及安全性。方法回顾性分析256例MPCNL治疗上尿路结石患者,男132例,女124例,平均(42.6±16.2)岁。左肾109例,右肾98例,双肾结石23例,鹿角状结石59例(直径3.0～8.6cm),多发性结石83例(包括并发鹿角状结石16例),输尿管上段结石37例,左侧15例,右侧22例(其中合并左肾结石8例,右肾结石6例)。256例患者中并发积水195例,无积水肾61例。采用逆行输尿管插管注生理盐水或30%泛影葡胺形成人工肾积水,在“C”臂监视下建立经皮肾盂通道。结果 233例肾结石一次取净结石189例、二次取净结石26例、三次取净结石5例;结石总取净率94.4%。13例残留结石患者术后经体外冲击波碎石(ESWL)治疗1月后复查KUB,结果提示结石排净。37例输尿管上段结石均一次取净结石,总取净率100%;单通道MPCNL223例、双通道33例;同时行双侧MPCNL18例。术后并发出血22例,17经输血等保守治疗治愈,5例经介入治疗痊愈。无1例中转开放手术。患者肾造瘘管留置5～10d,平均(6±2.2)d;平均住院时间(7.5±4.6)d。结论 MPCNL具有安全、损伤小、出血少、并发症少、恢复快等优点,是治疗肾及输尿管结石较理想的方法。 Objective To investigate the effectiveness and safety of minimally invasive percutaneous nephrolithotomy (MPCNL) in the treatment of upper urinary calculi. Methods A retrospective analysis of 256 cases of upper urinary tract calculi in patients with MPCNL, 132 males and 124 females, mean (42.6 ± 16.2) years old. 109 cases of left kidney, 98 cases of right kidney, 23 cases of double kidney stones, 59 cases of antlers (diameter of 3.0 ~ 8.6cm), 83 cases of multiple stones (including 16 cases of deer hornlike stones), 37 cases of upper ureteral calculi, 15 cases on the left and 22 cases on the right (including 8 cases of left kidney and 6 cases of right kidney). In 256 patients, there were 195 cases of hydrocephalus and 61 cases of hydronephrosis. The use of retrograde ureteral intubation with saline or 30% diatrizoate to form artificial hydronephrosis in the “C” arm monitoring the establishment of percutaneous renal pelvis access. Results A total of 233 nephrolithiasis stones were taken in 189 cases. 26 cases were taken twice by nephrolithiasis and 5 by nephrolithiasis. The total recovery rate of stones was 94.4%. Thirteen patients with residual stones underwent extracorporeal shock wave lithotripsy (ESWL) after 1-month review of KUB, the results suggest that the stone drain. 37 cases of upper ureteral stones were taken net stones, the total removal rate of 100%; single-channel MPCNL223 cases, double-channel 33 cases; simultaneous bilateral MPCNL18 cases. Postoperative bleeding in 22 cases, 17 were cured by conservative treatment such as blood transfusion, and 5 cases were cured by interventional therapy. No one case of open surgery. Patients with renal fistula indwelling 5 ~ 10d, an average of (6 ± 2.2) d; average length of stay (7.5 ± 4.6) d. Conclusion MPCNL is safe, less injury, less bleeding, fewer complications, rapid recovery, etc., is the ideal method for the treatment of kidney and ureteral calculi.