目的：比较输尿管软镜碎石术与经皮肾镜碎石术治疗肾结石的疗效和安全性。方法：2012年3月-2013年12月手术治疗的89例肾结石患者，其中37例采用组合式输尿管软镜钬激光碎石术治疗（URL组），52例采用经皮肾镜超声联合气压弹道碎石术治疗（PCNL组），比较两组的手术并发症和结石取净率。结果：URL组手术时间35-175min，平均58min；术后血红蛋白损失量为0-6g/L,平均2g/L；术后4例出现轻度贫血、3例出现发热，并发症发生率为18.9%（7/37）；手术成功率94.6%（35/37）；结石取净率为85.7%（30/35）。PCNL组手术时间30-86min,平均46min；术后血红蛋白损失量为4-36g/L,平均14g/L；术后21例出现轻度贫血、3例出现中度贫血进行输血治疗，其中1例行超选择性肾动脉栓塞术，术后4例出现发热，并发症发生率为53.8%（28/52）；手术成功率94.2%（49/52）；结石取净率为91.8%（45/49）。结论：PCNL治疗肾结石具有损伤小、并发症少、疗效确切等优点，但PCNL对肾实质有一定损伤，可能导致大出血，需输血治疗，甚至行超选择性肾动脉栓塞术。URL治疗肾结石则损伤更小、并发症更少，接近无创，而且疗效确切，特别在治疗肾结石合并脊柱侧弯等复杂性肾结石时具有独特的优势。关键词：输尿管软镜；经皮肾镜；肾结石

Objective:To compare the efficacy and safety of flexible ureteroscopy and percutaneous nephrolithotomy for renal calculi. Methods:From March 2012 to December 2013, 89 patients with renal calcul underwent operation, 37 patients were performed modular flexible ureteroscopy combined with holmiun laser lithotripsy (URL group), 52 patients were performed percutaneous nephrolithotripsy ultrasound combined with pneumatic lithotripsy (PCNL group) .The postoperative mortality and calculi-free rate between both groups were compared. Results:The operation time of URL group was 35-175min, and average time was 58 minutes.The amount of hemoglobin decrease was 0-6g/L, and average amount was 2g/L.4 patients suffered from mild anemia after the operation, and 3 patients suffered from fever. The complication rate was 18.9%(7/37).Success rate of operation was 94.6%(35/37).The calculi-free rate was 85.7%(30/35).The operation time of PCNL group was 30-86min, and average time was 46 minutes.The amount of hemoglobin decrease was 4-36g/L, and average amount was 14g/L.21 patients suffered from mild anemia after the operation, and 3 patients underwent blood transfusion because of moderate anemia, one of them underwent superselective renal artery embolization.4 patients suffered from fever after the operation. The complication rate was 53.8%(28/52).Success rate of operation was 94.2%(49/52).The calculi-free rate was 91.8%(45/49). Conclusion:The method of PCNL for renal calculi has the advantages of small damage, few complication and exact efficacy.But PCNL damaged renal parenchyma, would lead to hemorrhage, needed blood transfusion, even needed superselective renal artery embolization.The method of URL for renal calculi has the advantages of smaller damage, less complication, close to noninvasive and exact efficacy.URL has unique advantages for complex renal calculi such as renal calculi complicated with scoliosis. Key Words: flexible ureteroscopy; percutaneous nephrolithotomy; renal calculi