探讨二期原通道经皮肾镜联合输尿管软镜碎石取石术（RIRS）治疗经皮肾镜取石术（PCNL）后残余结石的安全性与可行性。

回顾性分析2018年9月至2022年8月广东医科大学附属医院收治的22例复杂性肾结石一期接受PCNL术后有残石患者的临床资料。男13例，女9例；平均年龄（58±14）岁，左侧13例，右侧9例，残石最大径（45±20）mm，残石最大横截面积（450±214）mm²。术前尿培养阳性10例。所有病例均接受原通道PCNL联合RIRS二期取石。

22例双镜联合取石术均顺利完成。平均手术时间（89±25）min，术后住院时间（3.5±1.4）d。术后短期并发症发生率为27.3%（6/22），其中2例术后发热，抗感染后好转，1例术后输血。术后1～6 d复查腹部平片或CT平扫，结石清除率为77.3%（17/22），行辅助治疗后最终清石率为86.4%（19/22）。

二期原通道经皮肾镜联合输尿管软镜碎石取石术治疗肾镜术后残石安全可行，值得临床推广。

To investigate the clinical safety and feasibility of post-PCNL residual stones treated with original access PCNL combined RIRS.

The clinical data of 22 cases with post-PCNL residual stones due to complex nephrolithiasis from September 2018 to August 2022 in Affiliated Hospital of Guangdong Medical University were analyzed retrospectively, including 13 males and 9 females, with the average age of (58±14) years. All patients were treated by the original access PCNL combined with RIRS in second stage, including 13 cases in the left and 9 cases in the right. The maximum diameter of the residual stone was (45±20) mm. The maximum cross-sectional area of the residual stone was (450±214) mm². Preoperative urine culture was positive in 10 cases.

All operative procedures of PCNL combined with RIRS in 22 patients were accomplished successfully. The mean operative time was (89±25)min and the mean postoperative stay was (3.5±1.4) d. The short-term postoperative complication rate was 27.3%(6/22). Two patients had postoperative fever, which improved with anti-infection, one case required postoperative blood transfusion. The stone free rate was 77.3% (17/22) assessed by abdominal plain film or CT scan 1 to 6 days after operation. The final stone free rate was 86.4%(19/22) after adjuvant therapy.

PCNL combined with RIRS for treating residual stone fragments after PCNL in complex nephrolithiasis is safe and feasible, which deserves clinical application.