目的探讨在体外冲击波碎石机下经皮肾镜取石术(PCNL)治疗肾结石和输尿管上段结石(第三腰椎以上)的方法以及与体外冲击波碎石术(ESWL)联合应用的效果。方法分析47例采用PCNL治疗肾结石和输尿管上段结石(其中2例经PCNL术和ESWL联合应用)的患者资料。男35例,女12例,平均年龄36岁。其中肾盂结石17例,肾盂和肾盏多发结石11例,肾盏结石3例,肾鹿角形结石6例,双肾结石3例,输尿管上段结石7例。2例肾鹿角形结石经PCNL后有一块结石被水流冲至上组肾盏,最后采取ESWL方法击碎排出。结果38例患者一期取石,5例二期取石,三期取石2例。45例均采用单通道取石。结石清除率89%(39/45),平均手术时间125min,平均住院12d。术中大出血2例中转开放手术,术后无继发出血,未见严重并发症。结论PCNL具有创伤小、较安全、出血少、并发症少、恢复快等优点,特别是在体外冲击波碎石机下经皮肾镜取石术治疗肾结石和输尿管上段结石时发生结石向上组肾盏移位、PCNL无法处理时采用ESWL碎石,患者无需搬动就可以碎石,同时可以利用体外冲击波碎石机C臂X光定位下一次穿刺成功,做到一机多用,医疗资源整合利用。 Objective To investigate the efficacy of percutaneous nephrolithotomy (PCNL) in the treatment of renal calculi and upper ureteral calculi (third lumbar spine) under ESWL and the effect of ESWL combined with extracorporeal shock wave lithotripsy. Methods Forty-seven patients undergoing PCNL for the treatment of renal calculi and upper ureteral calculi (2 of whom were treated with PCNL and ESWL) were analyzed. 35 males and 12 females, average age 36 years old. Among them, 17 cases were renal pelvis, 11 cases were multiple pelvis and calyx, 3 cases were calyceal calculus, 6 cases were renal deer horns, 3 cases were bilateral renal calculus, and 7 cases were upper ureteral calculus. 2 cases of deer antragodular stone by PCNL after a piece of stone was washed away by water flow to the upper calyx, ESWL last resort to crushing discharge. Results 38 cases of patients with a stone, 5 cases of second stage stone, three cases of stone in 2 cases. 45 cases were used single-channel stone. The stone removal rate was 89% (39/45), the average operation time was 125 minutes and the average hospitalization was 12 days. 2 cases of intraoperative bleeding in open surgery, no secondary bleeding after surgery, no serious complications. Conclusion PCNL has the advantages of less trauma, safer, less bleeding, less complications and faster recovery. Especially in the extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy is used to treat kidney stones and upper ureteral calculi. When the PCNL can not be treated, ESWL lithotripsy can be used. The patient can be crushed without moving. At the same time, the C-arm X-ray positioning of extracorporeal shock wave lithotripsy can be used successfully for the next puncture.