摘要目的： 探讨俯卧分腿位超声引导下不置输尿管导管经皮肾镜取石术治疗肾结石和输尿管上段结石的有效性和安全性。方法： 对2017年1月–2019年1月收治的417例接受经皮肾镜治疗的肾结石和输尿管上段结石的患者进行病例对照研究。研究组入组患者260例,术中不逆行放置输尿管导管,对照组入组患者157例,术中经尿道逆行放置F5输尿管导管。比较两组患者的肾穿刺造瘘成功率、总手术时间、麻醉时间、穿刺肾盏的比例、通道大小的比例、术后住院时间、术后留置肾造瘘管时间、术后血红蛋白下降量、结石清除率及围手术期并发症发生率。结果： 所有病例均能成功进行肾穿刺造瘘。两组结石清除率差异无统计学意义（90.4％ vs. 91.8％,P=0.632),研究组的总手术时间和麻醉时间比对照组显著缩短,分别为（46.2±10.9）vs.（59.9±12.0）min（P<0.001）和（77.4±10.9）vs.（96.6±11.3）min（P<0.001）,结石下移需输尿管镜处理的发生率两组差异无统计学意义,研究组术后感染相关并发症发生率显著低于对照组（1.9% vs. 7.1%,P=0.004）。结论： 俯卧分腿位超声引导下PCNL不置输尿管导管可更有效、更安全地用于治疗目标肾盏或肾盂分离≥10 mm的肾结石或者输尿管上段结石,值得进一步研究和推广。
Abstract：Objective： To evaluate the efficacy and safety of the prone split-leg position ultrasound-guided percutaneous nephrolithotomy without ureteral catheter in the treatment of renal calculi and upper ureteral calculi. Methods： A retrospective case-control study was conducted on a total of 417 cases of positive renal calculi and/or upper ureteral calculi. There were 260 cases of non-retrograde ureteral catheterization in the study group and 157 cases of retrograde ureteral catheterization of F5 in the control group. Both groups were operated on in the prone split-leg position. The success rate of renal puncture fistula, total operation time, anesthesia time, proportion of puncture of renal calyx, proportion of channel size, postoperative hospitalization time, postoperative indwelling time of renal fistula, postoperative decrease of hemoglobin, stone clearance rate and incidence of perioperative complications in the two groups were compared. Results： Renal puncture and fistula were successfully performed in all patients. Stone free rates (SFRs)were not statistical different between 2 groups (90.4% vs. 91.8%, P=0.632). Mean operative and anesthesia time were significantly shorter in study group (46.2±10.9 vs. 59.9 ±12.0 min, P<0.001, and 77.4±10.9 vs. 96.6±11.3 min, P<0.001, respectively).The incidence of infection-related complications was significantly lower in study group (1.9% vs. 7.1%, P=0.004). Conclusion： It is more effective and safer to use ultrasound-guided PCNL without ureteral catheter in prone split-leg position for the treatment of renal calculi and/or upper ureteral calculi with renal pelvis or renal calices dilated 10 mm or above.
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