探讨CT、B超预定位"三步法"经皮肾镜碎石取石术（PCNL）治疗上尿路结石的安全性、实用性、有效性。

对2018年3月至2022年3月在娄底市中心医院确诊的肾结石210侧，输尿管上段结石138侧进行回顾性分析。其中研究组164侧采用俯卧位CT、B超预定位"三步法"PCNL手术。对照组184侧，术中仅用徒手黑白B超（凸阵探头3.5 MHz）引导定位方法，开展俯卧位传统PCNL手术。

研究组2例术后发热，保守治疗好转。对照组6例术后出现发热，1例经脾建立通道，11例经胸膜建立通道，均保守治疗好转。26例术后出血，其中23例夹闭肾造瘘管等保守治疗好转，2例大出血超选择性栓塞止血，1例改开放肾切除止血。两组手术穿刺时间分别为3（3.0，5.0）min及8（7.5，10.0）min，一次性穿刺成功率分别为98.2%及82.1%，一期结石清除率分别为97%及71.7%。两组患者在穿刺时间、一次性穿刺成功率、一期结石清除率及术后并发症指标差异存在统计学意义（P<0.05）。

CT、B超预定位"三步法"PCNL术治疗上尿路结石较传统PCNL术更安全、实用、有效，可以降低学习曲线，提高结石清除率、降低并发症发生率。

To investigate the safety, practicability and effectiveness of CT and B-ultrasound pre-positioning "three-step" percutaneous nephrolithotomy (PCNL) for the treatment of upper urinary tract calculi.

From March 2018 to March 2022, the data of 210 renal calculi and 138 upper ureteral calculi diagnosed in Loudi Central Hospital were retrospectively analyzed. Among them, 164 sides of the study group were operated with "three-step" PCNL with prone position CT and B ultrasonic pre-positioning. In the control group, 184 sides were operated with traditional PCNL in prone position only by manual black and white ultrasound (convex array probe 3.5 MHz) guiding the position.

Two patients in the study group experienced postoperative fever and improved after conservative treatment. In the control group, 6 cases experienced postoperative fever, 1 case established a channel through the spleen, and 11 cases established a channel through the pleura, all of which improved after conservative treatment. There were 26 cases of postoperative bleeding, of which 23 cases improved after conservative treatment such as clamping renal fistulas, 2 cases of massive bleeding were treated with superselective embolization, and 1 case was changed to open nephrectomy for hemostasis. The puncture time for the two groups of surgeries was 3 (3.0, 5.0) min and 8 (7.5, 10.0) min, respectively. The success rates of one-time puncture were 98.2% and 82.1%, and the primary stone clearance rates were 97% and 71.7%, respectively. There were significant differences in puncture time, one-time puncture success rate, primary stone clearance rate, and postoperative complications indicators (P<0.05).

The "three-step" PCNL with CT and B-ultrasound pre-positioning is safer, more practical and more effective than the traditional PCNL in the treatment of upper urinary tract calculi, which can reduce the learning curve, improve the stone clearance rate and reduce the incidence of complications.