【摘要】 目的 探讨微创经皮肾镜下钬激光碎石术治疗上尿路结石的方法及疗效。 方法 2007年9月-2010年10月在B型超声引导下应用微创经皮肾镜下钬激光碎石术治疗上尿路结石138例，其中肾鹿角形结石64例，单发肾盂、肾盏结石38例，双肾结石8例，输尿管上段结石28例，孤立肾结石2例。 结果 136例取石成功，其中95例一期取石成功（包括双通道取石5例），41例二期取石，2例因经皮肾穿失败改行开放手术取石。27例术后体外震波碎石治疗。平均结石清除率78.9%（109/138）。平均手术时间112 min，平均住院时间10 d，肾造瘘管平均留置时间4 d，双J管平均留置时间4周。5例因术中出血较多需输血。11例术后1周内出血较多，其中3例需要输血。12例出现尿外渗。7例术后出现高热（gt;39 ℃）。随访: 98例伴有肾积水，时间3~6个月，平均4个月，24例积水消失，68例积水减轻，6例无改善也无加重；22例残余结石随访4~9个月，平均6个月，6例结石增大，16例结石无变化；87例随访12个月无残余结石，7例结石复发。 结论 微创经皮肾镜下钬激光碎石术治疗上尿路结石创伤小，恢复快，并发症少，疗效满意。【Abstract】 Objective To discuss the method and the curative effect of minimally invasive percataneous nephrolithotomy (mini PCNL) with holmium laser in treating upper urinary tract calculi. Methods From September 2007 to October 2010, 138 patients with upper urinary tract calculi were treated with mini PCNL with holmium laser under the conduction by type-B ultrasonography. Of the 138 cases, 64 patients had staghorn calculi, 38 had single renal pelvis or renal calyx stones, eight had bilateral renal calculi, 28 had upper-ureteral calculi, and two had solitary kidney calculi. Results Successful stone removal was achieved in 136 cases, among which there were 95 cases of stage-one nephrolithotomy (double tracts were used in five cases) and 41 cases of sfage-two neploolithotomy. Two cases were changed to open operation due to failures of percutaneous nephrolithotory. Extracorporeal shock-wave lithotomy was used in 27 cases after operation. The average stone removal rate was 78.9% (109/138). The average operation time was 112 minutes. The average hospital stay was 10 days. The average nephrostomy tube stay was four days. The average double J tube stay was four weeks. Five patients needed blood transfusion in operations due to a large amount of blood loss. Eleven patients suffered from massive hemorrhage one week after operation and blood transfusion was performed in three patients. Urine exosmosis happened in 12 cases. And there were seven cases of high fever (gt;39 ℃) after operation. Follow-up was done for 98 patients accompanied by hydronephrosis for a time period ranged from three to six months averaging at four months. Hydronephrosis disappeared in 24 patients, alleviated in 68 cases, and did not change in six cases. Twenty-two cases of residual calculi were followed up for a period ranged from four to nine months averaging at six months. Enlarged calculi occurred in six cases and no change happened to the calculi in 16 cases. Eighty-seven patients without residual calculi were followed up for 12 months, and there were seven cases of reoccurrence. Conclusion Treatment of upper urinary tract calculi with minimally invasive percutaneous nephrolithotomy with holmium laser is a simple and safe method with little injury, quick recovery, few complications and satisfactory results.