探讨肾盂肾上盏漏斗夹角（UIPA）对输尿管镜下激光碎石术治疗成熟壶腹型肾盂患者输尿管上段结石的影响。

回顾性分析2019年1月至2021年1月在山西医科大学第一医院治疗的58例采用输尿管硬镜治疗输尿管上段结石患者的临床资料。男17例，女41例，年龄34~71岁，平均（42±11）岁。纳入的患者均为单侧输尿管上段结石，结石直径0.8 cm~2.1 cm，平均（1.3±0.8）cm。术前均行非增强CT和静脉肾盂造影检查，确认肾盂类型，测量UIPA大小，其中UIPA<20°者39例，21°~30°者15例，>30°者4例。

纳入58例患者均为成熟型肾盂，5例患者硬镜无法碎石遂中转为输尿管软镜治疗，该5例患者均为男性，其中4例UIPA>30°，1例UIPA为21°~30°，硬性输尿管镜一次性碎石成功率为91.4%（53/58）。53例患者手术时间为（48±21）min，术后住院（1.4±1.0）d。术后1~3月拔除双J管，随访1~3个月，随访期间，行泌尿系平片确认结石清除情况，清石率为88.7%（47/53）。

UIPA能初步判断输尿管硬镜能否进入上盏并完成碎石，结合术前影像学分析可以分层选择治疗输尿管上段结石，减少输尿管软镜的使用，降低患者的经济负担。

To investigate the effect of the upper infundibulopelvic angle (UIPA) on the treatment of mature ampullary upper ureter calculi by ureteroscopic holmium laser lithotripsy.

The clinical data of 58 patients with upper ureteral calculi treated with hard ureteroscope in First Hospital of Shanxi Medical University from January 2019 to January 2021 were retrospectively analyzed. There were 17 males and 41 females, aged 34-71 years, with an average age of (42±11) years. All the included patients had unilateral upper ureteral calculi with a diameter of 0.8 cm-2.1 cm, an average of (1.3±0.8) cm. Preoperative non-enhanced CT and intravenous pyelography were performed to confirm the type of renal pelvis and the UIPA. Among them, 39 cases had UIPA <20°, 15 cases had UIPA between 21° and 30°, and 4 cases had UIPA >30°.

All the 58 patients were mature renal pelvis, and 5 patients was converted to flexible ureteroscopy. All five patients were males. Four had a UIPA of over 30°, and one had a UIPA between 21° and 30°. The success rate of one-time stone fragmentation using rigid ureteroscopy was 91.4% (53/58). The operation time of the 53 patients was (48±21) min. The postoperative hospitalization was (1.4±1.0) days. Double J tubes were removed 1-3 months after the operation, followed up for 1-3 months. During the follow-up, plain films of the urinary system were performed to confirm the stone clearance, and the stone clearance rate was 88.7%(47/53).

UIPA can preliminarily determine whether a rigid ureteroscope can enter the upper calyx and complete the lithotripsy. Combined with preoperative imaging analysis, UIPA can be used for upper ureteral stones to reduce the use of flexible ureteroscopes and the economic burden of patients.