目的:分析穿刺针配合组合式输尿管软镜处理难治性肾下盏结石的安全性及有效性。方法:58例单侧肾下盏结石患者,全身麻醉,取患侧抬高30~35°斜截石位,输尿管软镜找到目标结石,插入钬激光光纤后因光纤韧性使得软镜无法达到原来弯曲度,不能触及结石,采用经超声引导穿刺针经皮穿刺肾下盏以结石肾盏为目标,用穿刺针尖将肾盏内结石移动顶起;如结石位置不满意,可退出针芯,导入斑马导丝,输尿管软镜直视下,调整导丝方向,将结石托起甚至移动到肾盂的方法,予以碎石。术后常规留置F5双J管4~6周,导尿管2~4d。术后2d行尿路平片检查,了解结石粉碎情况及双J管位置。结果:58例患者中,结石寻及率94.8%(55/58),碎石成功率94.8%(55/58),其他方法碎石3例。手术时间35~90min,平均60min,无输尿管穿孔及撕脱、感染性休克、胸腔积液及肠管损伤等严重并发症。术后住院时间3~4d。术后2d行尿路平片检查,58例结石排净,无结石残留(包括其他手术方法碎石)。结论:超声引穿刺针经皮穿刺目标结石的肾下盏,穿刺针尖及斑马导丝配合输尿管软镜处理难治性肾下盏结石,安全可靠,碎石有效。 Objective: To analyze the safety and efficacy of puncture needle combined with ureteroscopy in the treatment of refractory lower calyceal calculus. Methods: 58 patients with unilateral renal calyceal stones under general anesthesia, the affected side elevation of 30 ~ 35 ° oblique stone, ureteroscopic find the target stone, insert the holmium laser fiber due to the optical fiber flexibility so that the original can not be achieved by the soft mirror Curvature, can not touch the stones, the use of ultrasound-guided percutaneous puncture of kidney under the calyceal calculus as the goal, with the puncture tip within the calyceal calculus will move up; if not satisfied with the location of stone, you can exit the needle core Zebra guide wire, ureteroscopy under direct vision, adjust the guide wire direction, the stone care or even move to the renal pelvis method, to be gravel. Postoperative conventional F5 double J tube 4 to 6 weeks, catheter 2 ~ 4d. Urine plain film examination 2d after operation to understand the situation of stone crushing and double J tube position. Results: Among the 58 patients, the rate of stone finding was 94.8% (55/58), the success rate of gravel was 94.8% (55/58), and the other methods were gravel in 3 cases. Surgery time 35 ~ 90min, an average of 60min, no ureter perforation and avulsion, septic shock, pleural effusion and bowel injury and other serious complications. Postoperative hospital stay 3 ~ 4d. 2d postoperative urinary plain film examination, 58 cases of stone row net, no stone residue (including other surgical methods of gravel). Conclusion: Ultrasound-guided puncture of percutaneous mandibular calculus under the kidney, puncture tip and zebra guide wire with ureteroscopic treatment of refractory renal calyceal stones, safe, reliable, gravel effective.