中文摘要：

目的：比较上盏、中盏、下盏穿刺的微创经皮肾镜取石术（MPCNL）治疗复杂性肾结石的临床有效性和安全性。方法：前瞻性收集2014年7月~2015年8月在我院行MPCNL的复杂性结石病例,共纳入376例复杂性结石患者,比较上盏穿刺、中盏穿刺和下盏穿刺的微创经皮肾镜碎石取石术治疗复杂性肾结石。结果：376例患者中,男218例,女158例。平均年龄49.4岁。左肾203例,右肾173例。多发结石211例,部分鹿角结石115例,完全鹿角结石50例。上盏组108例,年龄（50.3±11）岁,结石负荷（927.3±628.7）mm^2;中盏组190例,年龄（48.6±11.7）岁,结石负荷（947.8±773.6）mm^2;下盏组78例,年龄（50.4±10.8）岁,结石负荷（820.5±496.2）mm^2,三组比较差异均无统计学意义（P〉0.05）。下盏通道建立时间明显高于上盏（P=0.03）和中盏（P=0.009）,48小时及3个月结石清除率则差异无统计学意义,术后并发症差异无统计学意义。结论：MPCNL在上盏穿刺、中盏穿刺及下盏穿刺的有效性及安全性基本接近一致。对比之下,下盏穿刺所需要的时间较多。

英文摘要：

Objective：To evaluate the effectiveness and safety among upper puncture,middle puncture and lower puncture of minimally invasive percutaneous nephrolithotomy（MPCNL）in complex stones.Method：A total of 376 patients with complex kidney stones treated by upper puncture,middle puncture and lower puncture of MPCNL from July 2014 to August 2015 were prospectively analyzed.Result：Among 376 patients,218patients were males and 158 patients were females,203 patients were found left kidney stones and 173 patients were found right kidney stones,211 patients were found multiple stones,115 patients were found partial staghorn stone and50 patients were found complete staghorn stone.One hundred and eight patients with a mean age of（50.3±11）years old and mean stone burdon of（927.3±628.7）mm^2 were treated by upper puncture of MPCNL.One hundred and ninety patients with a mean age of（48.6±11.7）years old and mean stone burdon of（947.8±773.6）mm^2 were treated by middle puncture of MPCNL.Seventy-eight patients with a mean age of（50.4±10.8）years old and mean stone burdon of（820.5±496.2）mm^2 were treated by lower puncture of MPCNL.There were no statistical difference among three groups on mean age and stone burdon（P〉0.05）.The group of lower puncture have a longer access time than the upper（P=0.03）and the middle（P=0.009）.But there were no statistical difference among them on one-stage stone free rate（SFR）,two-stage SFR and postoperative complications.Conclusion：Patients with complex stones treated with upper,middle and lower puncture might experience the same efficacy and safety,but the access time of lower puncture of MPCNL is longer.