目的:探讨手术方案的选取对复杂性输尿管上段结石(CUU)患者临床疗效及取石碎石效果的影响差异。方法:回顾性分析348例CUU患者临床资料,分别从输尿管镜下气压弹道碎石术(URSL)、经皮肾穿刺取石术(PCNL)、体外冲击波碎石术(ESWL)及后腹腔镜下输尿管上段切开取石术(RLU)等4种术式患者中各随机抽取33例,分别纳入A、B、C、D四组(此次共132例有效病例入组)。比对其碎石时间、术程、术中失血量、总住院时间、治疗费用等围手术期指标差异,记录其一次性手术成功率、结石清除率(SFR)、二次或多次手术率及术后相关并发症发生情况,分析结石成分。结果:A、C组相关围手术期指标及一次性手术成功率、SFR均显著低于B、D组(P<0.05),二次或多次手术率则显著高于B、D组,均差异有统计学意义(P<0.05)。在术后为期12个月的随访中,B组不良反应发生率为48.5%,显著高于其他三组(P<0.05)。四组患者均以草酸钙结石所占比例最高,组间对比差异无统计学意义(P>0.05)。结论:URSL术程短、创伤小,但一次性手术成功率及SFR较低;PCNL治疗SFR理想,但术后并发症发生风险高;ESWL治疗费用低、创伤小、无需术后住院,但一次性手术成功率及SFR较低;RLU一次性手术成功率及SFR均高,且术后并发症发生风险低,但手术误伤概率较大;临床需综合考虑实际情况选择最佳术式。 Objective: To investigate the effect of selecting the surgical regimen on the clinical curative effect and lithotripsy effect in patients with complicated upper ureteral calculi (CUU). Methods: The clinical data of 348 patients with CUU were retrospectively analyzed. The clinical data of patients with CUU were retrospectively analyzed. They were reviewed by ureteroscopic pneumatic lithotripsy (URSL), percutaneous nephrolithotomy (PCNL), extracorporeal shock wave lithotripsy (ESWL) and retroperitoneal ureter Thirteen patients were randomly selected from four surgical procedures, including upper abdomen lithotomy (RLU), and were randomly divided into four groups: A, B, C and D (132 valid cases were enrolled in this study). Compared with the perioperative indexes such as gravel time, operation schedule, intraoperative blood loss, total length of hospital stay, and treatment costs, the success rate of one-time operation, the rate of stone clearance (SFR), the rate of two or more operations And postoperative complications related to the situation, analysis of stone components. Results: The perioperative indexes, one-time success rate and SFR of group A and group C were significantly lower than those of group B and D (P <0.05), and the rate of second or multiple operation was significantly higher than that of group B and D The difference was statistically significant (P <0.05). In the 12-month follow-up, the incidence of adverse reactions in group B was 48.5%, significantly higher than the other three groups (P <0.05). The four groups of patients with the highest proportion of calcium oxalate stones, no significant difference between the two groups (P> 0.05). Conclusions: URSL has shorter operative procedure and less trauma, but the success rate of one-off surgery and SFR is lower. PCNL is ideal for treating SFR, but the risk of postoperative complications is high. ESWL has low cost, less trauma and no postoperative hospitalization. The successful rate and SFR of sexual operation were lower; the successful rate of one-time operation of RLU and SFR were both high, and the risk of postoperative complications was low, but the probability of surgical injury was higher; and the best surgical method should be selected according to the actual situation.