目的

争取一个周期内完成未预置支架近端输尿管结石患者的治疗。

方法

针对半刚性输尿管镜（sURS）手术中可能会遇到的困难制定了一个应对路径，对2022 年～2023 年间符合入组标准并按路径执行的患者资料进行回顾，共148 例（156 侧）。

结果

148 例患者中Ⅰ期完成治疗143 例（96.6%），Ⅱ期治疗5 例（3.4%），2 例（1.4%）术后24 h 有发热，无脓毒症病例，无Traxer 4 级输尿管损伤病例，随访6～12 个月，无肾积水病例。本研究报告未预置支架近端输尿管结石患者初次使用8/9.8 Fr sURS 进入成功率为73.7%，同轴扩张后进入成功率提高到82.1%，即使改用4.5/6.5 Fr sURS 仍会因上行困难而无法接触到结石，发生率9.6%。

结论

多环节“输尿管黏膜保护”意识下多种技术组合的应对路径实施后的效果与安全性良好，能够最大程度地争取一个周期内完成对患者的治疗。

Objective

To improve the treatment success rate of retrograde ureteroscopy in patients with proximal ureteral stones without a preset stent during a single hospitalization.

Methods

A coping path was developed for the difficulties encountered in semi-rigid ureteroscopy （sURS） surgery， and the data of 148 patients （156 sides） with proximal ureteral calculi who met the inclusion criteria and underwent the surgery according to the coping path between 2022 and 2023 were reviewed.

Results

Of the 148 patients included，143 （96.6%） completed the first stage treatment and 5 （3.4%） completed the second stage treatment. Two（1.4%） patients had fever 24 hours after operation， but there was no sepsis or Traxer grade 4 ureteral injury.No hydronephrosis was observed during a follow-up period of 6 to 12 months. In this study， patients with proximal ureteral stones without a preset stent had a 73.7% success rate of initial 8/9.8 Fr sURS placement.This rate improved to 82.1% after coaxial dilatation. Switching to ultrafine （4.5/6.5 Fr） sURS still prevented access to stones due to difficulty in ascending in 9.6% of cases.

Conclusion

With the awareness of multilink "ureteral mucosal protection"， the path to cope with difficult ureteral calculi through a combination of techniques is effective and safe， and can help complete the treatment of patients within a single hospitalization to the greatest extent.