目的：探讨微创经皮肾穿刺取石术(MPCNL)治疗肾结石的疗效。方法：采用MPCNL治疗41例肾结石患者，其中肾石30例(结石直径gt;2.0 cm)，输尿管上段结石11例(结石直径1.0～2.0 cm)；单侧结石37例，双侧结石4例。结果：41例手术均获成功。手术时间45～120 min，平均52.7 min，无一例改开放手术。本组肾结石病例单次结石清除26例(86.7%)，4例残余结石行二期手术取净；输尿管上段单次结石清除率100%。结论：MPCNL 是一种有效的治疗肾结石的方法，并具有创伤小、取石率高、恢复快等优点。
ObjectiveTo systematically review the effectiveness and safety of transurethral ureteroscopy lithotripsy in the treatment of upper ureteral calculi. MethodsWe electronically searched The Cochrane Library (Issue 3, 2013), PubMed (1966 to 2013.8), EMbase (1990 to 2013.8), CNKI (1949 to 2013.9), CBM (1978 to 2013.9), VIP (1989 to 2013.8) and WanFang Data (1990 to 2013.8) for the randomized controlled studies (RCTs) related to retroperitoneoscopy ureterolithotomy versus transurethral ureteroscopy lithotripsy for upper ureteral calculi. Two reviewers independently screened literature, extracted data, and evaluated methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2 software. ResultsA total of 16 RCTs involving 1 410 patients (transurethral ureteroscopy lithotripsy:747 cases; etroperitoneal laparoscopic ureterolithotomy:663 cases) were included. The results of meta-analysis showed that, transurethral ureteroscopy lithotripsy was lower than retroperitoneoscopy ureterolithotomy in success rates of surgery (OR=0.26, 95%CI 0.14 to 0.51), 3-day stone clearance rates (OR=0.06, 95%CI 0.03 to 0.11), and 1-month stone clearance rates (OR=0.21, 95%CI 0.08 to 0.53), while it showed superiority in operation time (MD=-22.35, 95%CI-35.29 to-9.41) and postoperative hospital stay (MD=-1.84, 95%CI-3.44 to-0.24). ConclusionCurrent evidence shows that, in the treatment of upper ureteral calculi, transurethral ureteroscopy lithotripsy causes less operation time and postoperative hospital stay, but it had no advantage in success rates of surgery, 3-day stone clearance rates, and 1-month stone clearance rates.