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目的：比较输尿管软镜钬激光碎石术（FURS）与经皮肾镜取石术（PCNL）治疗直径＜20mm肾结石的差异。方法：分析2010年11月至2013年8月收治的直径＜2c m行ESWL失败的119例132侧肾结石患者的临床资料及治疗方法。其中采用输尿管软镜钬激光碎石术（FURS）47例(52侧)，采用经皮肾镜钬激光碎石取石术(PCNL)72例(80侧)。分为比较分析两种方法治疗结石的手术时间、一期结石清除率、术后住院天数、治疗费用和并发症。结果：FURS组47例(52侧)和P C N L组72例(80侧)，结石平均直径分别为(14.9±2.7)mm和(15.9±2.1)mm，差异无统计学意义(P＞0.05)。两组患者年龄、肾积水情况、结石直径等比较差异无统计学意义(P＞0.05)。FURS组手术均顺利完成，术后无发热，未出现严重并发症。PCNL组手术均顺利完成，术后发热3例，术中、术后明显出血2例，经选择性肾动脉栓塞治愈1例，经选择性肾动脉栓塞治疗无效，行患侧肾切除1例。FURS组和PCNL组手术时间分别为(81.0±24.3)min及(60.7±19.4)min，一期结石清除率分别为80.8％(38/47)及91.7％(66/72)，组间比较差异无统计学意义(P＞0.05)；治疗费用分别为(56320.7±14253.4)圆及(18247.2±74844.1)圆，住院天数分别为(3.2±0.8)d及(6.7±2.7)d，组间比较差异均有统计学意义(P＜0.05)。结论：对于直径＜20mm行ESWL失败的肾结石患者，FURS碎石时间相对较长，但其经自然腔道内镜手术的特点使其并发症发生率明显低于PCNL，FURS组术后住院时间明显短于PCNL组。大多数FURS组患者术后1d即可出院，说明FURS对患者的影响小、患者恢复快，科体现“无创”优势，但因手术器械成本限制，FURS治疗费用较高。“,”Objective To compare the safety and efficiency between flexible ureteroscopy holminum laser(FURS) and percutaneous nephrolithotripsy holminum laser(PCNL) in management of renal calculi.Methods Analysis from November 2010 to August 2013 were the diameter of the0.05.There was no significant difference between the groups in base-line parameters. FURS group were successfully completed surgery, postoperative fever, no severe complications. PCNL group were successfully completed surgery, postoperative fever (3 cases), intraoperative and postoperative obvious hemorrhage in 2 cases, 1 case was cured by selective renal artery embolization, and the selective renal artery embolization is invalid, 1 case of bilateral renal resection. Procedure time was (81.0±24.3)and (60.7±19.4) min, P<0.05, stone free rates(residual fragments≤4mm)were 80.8%(38/47)and 91.7%(66/72), P<0.05, hospitalization expenses were (56320.7±14253.4) yuan and (18247.2±7484.10) yuan, P<0.05, postoperative hospitalization stay were(3.2±0.8) and (6.7±2.7)days.Conclusions For diameter<20 mm ESWL failure of patients with kidney stones, FURS gravel time is relatively long, but its natural orifice translumenal endoscopic surgery characteristics make it a significantly lower incidence of complications of PCNL, postoperative hospital stay FURS group was obviously shorter than a set of PCNL. Most FURS group of patients with postoperative 1 d can be discharged from the hospital, that FURS small impact on patients, patients recover quickly, embody “noninvasive” advantage, but because of surgical instruments cost limit, FURS hospitalization expenses is higher.