比较经皮肾镜碎石取石术（PCNL）与体外冲击波碎石术（ESWL）对高密度肾输尿管上段结石的疗效。

收集凤庆县人民医院直径大小10~20 mm肾输尿管上段结石患者，结石密度≥1 000 Hu，根据患者意愿分别接受mini-PCNL或ESWL治疗。分析比较两组的临床资料。

两组患者的结石最大径、结石密度及肾积水程度差异无统计学意义。PCNL组的结石清除率为100%，而ESWL组结石清除率为40%，两组结石清除率差异有统计学意义（P<0.001）。两组患者术前后的血红蛋白下降差异无统计学意义，但PCNL组有2例患者术后需要输浓缩红细胞200 ml。术后并发症方面，PCNL有1例患者出现发热，口服药物后自行好转，而ESWL组8例患者术后1个月内出现发热，腰痛不适，均非计划再次住院治疗，两组在术后并发症（P=0.033）及术后非计划住院（P=0.003）差异有统计学意义。PCNL组的手术时间和术后住院时间均较ESWL组长。

对于10~20 mm高密度肾输尿管上段结石，mini-PCNL比ESWL更有效，mini-PCNL的优点是清石率高，无需再治疗和再住院。

To compare the efficacy of percutaneous nephrolithotomy (PCNL) and extracorporeal shock wave lithotripsy (ESWL) in the treatment of high-density renal calculi and upper ureteral calculi.

The patients with diameter of 10-20 mm, high-density (≥1 000 Hu) renal calculi and upper ureteral calculi in the People’s Hospital of Fengqing were collected and were assigned to PCNL group or ESWL group. The data were compared.

There were no significant difference in the maximum diameter of stone, stone density and degree of hydronephrosis between the two groups. The stone clearance rate of the PCNL group was 100%, while it was 40% in the ESWL group, showing a statistical difference between the two groups (P<0.001). There was no statistical difference in the decrease of hemoglobin between the two groups, but 2 patients in the PCNL group needed blood transfusion. One patient in PCNL group developed fever and was improved by oral administration, while 8 patients in ESWL group developed fever and low back pain, and were unscheduled hospitalization finally. There were statistical differences in postoperative complications (P=0.033) and unscheduled hospitalization (P=0.003) between the two groups. The operation time and postoperative hospital stay in PCNL group were longer than those in ESWL group.

The mini-PCNL is more effective than ESWL for 10-20mm high-density renal calculi and upper ureteral calculi. The advantage of mini-PCNL is high stone clearance rate and no need for retreatment and rehospitalization.