摘要目的:分析输尿管软镜碎石术联合体外超声波碎石与经皮肾镜碎石取石术治疗2～4 cm肾结石的临床疗效及患者满意度。方法:回顾性分析2017年7月—2019年10月徐州医科大学附属医院收治的136例结石最大直径为2～4 cm的肾结石患者的病例资料，根据治疗方法不同将其分为两组：观察组( n＝66)和对照组( n＝70)。观察组患者采用输尿管软镜碎石术联合术后体外超声波碎石治疗，对照组患者采用经皮肾镜碎石取石术治疗。分析比较两组患者的血红蛋白值、白细胞计数、术后并发症、结石清除率、住院费用、术后住院时间、手术时间、术后满意度及再次手术选择率。计量资料以均数±标准差( Mean± SD)表示，组间比较采用 t检验；计数资料组间比较采用 χ2检验。 结果:两组患者的结石清除率(81.82%比85.71%)、术后白细胞计数[(7.91±2.33)×10 9/L比(8.69±2.76)×10 9/L]、住院费用[(2.86±0.57)万元比(3.01±1.16)万元]、术后满意度(81.82%比74.29%)比较，差异均无统计学意义( P>0.05)。在术后住院时间[(1.99±1.27) d比(5.25±3.18) d]、术后血红蛋白下降值[(7.16±6.11) g/L比(15.14±8.69) g/L]、术后并发症发生率(12.1%比45.7%)方面，观察组均低于对照组，差异具有统计学意义( P<0.05)。在手术时间[(100.13±47.65)min比(75.66±30.17) min]、再次手术选择率(96.97%比65.71%)方面，观察组均高于对照组，差异具有统计学意义( P<0.05)。 结论:对于结石最大直径为2～4 cm肾结石的治疗，输尿管软镜碎石术联合体外超声波碎石临床疗效显著，并发症少，患者满意度高，值得临床推广应用。

abstractsObjective:To discuss the clinical efficacy and satisfaction of flexible ureteroscopy lithotripsy (FURL) combined with extracorporeal shock wave lithotripsy(ESWL) and percutaneous nephrolithotomy( PCNL) for renal calculi of 2-4 cm.Methods:The clinical data of 136 renal calculus patients in the Affiliated Hospital of Xuzhou Medical University from July 2017 to October 2019 were retrospectively analyzed.Then, According to different treatment methods, 66 patients receiving FURL combined ESWL were divided into the observation group and 70 patients treated with PCNL were divided into control group. The counts of hemoglobin and white blood cells, postoperative complications, rate of stone clearance, hospitalization expenses, postoperative length of hospitalization stay, duration of operation, satisfaction of patients and repeated selection rate of operation method were recorded and analysed. Measurement data were expressed as mean±standard deviation ( Mean± SD), comparison between groups were by t-test; comparison of count data between groups were by Chi-square test. Results:The stone clearance rate of the two groups of patients (81.82% vs 85.71%), postoperative white blood cell count [(7.91±2.33)×10 9/L vs (8.69±2.76)×10 9/L], hospitalization expenses [(2.86±0.57) ten thousand yuan vs (3.01±1.16) ten thousand yuan] and patient satisfaction (81.82% vs 74.29%), the difference were not statistically significant ( P>0.05). Postoperative hospital stay [(1.99±1.27) d vs (5.25±3.18) d], postoperative hemoglobin drop [(7.16±6.11) g/L vs (15.14±8.69) g/L], incidence of postoperative complications (12.1% vs 45.7%), the observation group was lower than the control group, and the difference were statistically significant ( P<0.05). In terms of operation time [(100.13±47.65) min vs (75.66±30.17) min] and the repeated selection rate of operation methods (96.97% vs 65.71%), the observation group was higher than the control group, and the difference was statistically significant ( P<0.05) . Conclusion:The clinical efficacy of FURL combined with ESWL in the treatment of 2- 4 cm renal calculus is better, which is beneficial to lower rate of postoperative complications, higher degree of patients’ satisfaction, and it is worthy of popularization and application.