目的:通过对我院37例急诊输尿管镜气压弹道碎石术治疗输尿管上段结石失败原因进行分析,为上段输尿管结石的治疗方法的选择提供依据,提高上段输尿管结石治疗的安全性及成功率。方法:我院自2012年1月至2015年12月行急诊输尿管镜气压弹道碎石术治疗上段输尿管结石共149例,将输尿管镜不能上行至结石部位击碎结石、结石漂移至肾盂、出现手术者并发症定义为手术失败,分析37例手术失败原因。结果:本研究中,19例输尿管狭窄导致输尿管镜上行失败,6例结石或者结石碎片上移至肾盂导致手术失败,3例输尿管结石远端肉芽组织至输尿管狭窄,3例因输尿管迂曲至手术失败,4例输尿管开口狭窄或者开口方向异常,术中导管及导丝均不能插入中转开放手术,1例因前列腺增生中叶凸入膀胱导致不能进镜而中转开放手术,1例因输尿管开口狭窄而用输尿管导管反复试行插入,导致输尿管膀胱壁段形成假道。结论:急诊行输尿管上段结石输尿管镜治疗有较高的成功率,但是因为输尿管上段结石位置高,多种原因均可导致手术失败,手术过程中适当调整操作、把握细节,可提高手术成功率,将风险降至最低。 OBJECTIVE: To provide a basis for the treatment of upper ureteral calculi and to improve the safety and success rate of upper ureteral calculi treatment through the analysis of 37 cases of emergency ureteroscopic pneumatic lithotripsy in the treatment of upper ureteral calculi. Methods: From January 2012 to December 2015, our hospital underwent emergency ureteroscopic pneumatic lithotripsy for the treatment of upper ureteral calculi in 149 cases. Ureteroscopy was unable to go up to the stone site to crush the stones and the stones drifted into the renal pelvis. Surgery The complication was defined as the failure of surgery and the causes of the failure were analyzed in 37 cases. RESULTS: In this study, 19 cases of ureteral stricture led to failure of ureteroscopic ascending, 6 cases of stone or stone fragments moved to the renal pelvis resulting in unsuccessful operation, 3 cases of distal ureteral calculi to ureteral stricture, 3 cases of tortuous ureter to surgery failure , 4 cases of ureteral stenosis or abnormal opening direction, intraoperative catheter and guide wire can not be inserted into the open surgery, 1 case of benign prostatic hyperplasia due to the bladder into the mirror can not lead to the transfer of open surgery, 1 case of ureteral open stenosis with Ureteral catheter repeatedly trial insertion, resulting in the formation of ureteral bladder wall segment fake. Conclusions: Ureteroscopic ureteroscopic treatment of upper ureteral calculi has a high success rate. However, due to the high position of upper ureteral calculi, various reasons may lead to the failure of operation. Appropriate adjustment operation during the operation can help to improve the success rate of operation, Minimize risk.