目的： 探讨输尿管软镜碎石术（flexible ureteroscopic lithotripsy，FURL）中采用可弯曲负压吸引鞘(flexible vacuum suction ureteral access sheath，FVSUAS)，通过碎、吸结合技术，术后出院不留置输尿管支架管治疗＞2 cm上尿路结石的临床疗效。方法： 收集2022年1月至2023年10月FURL术中采用FVSUAS治疗的＞2 cm上尿路结石患者43例的临床资料，与随机选取的同期常规FURL术治疗的40例患者进行对比，试验组选用FVSUAS进行FURL，术后3天拔除输尿管支架管出院；对照组采用常规的输尿管导引鞘（ureteral access sheath，UAS），术后常规留置输尿管支架管，4周后二期膀胱镜或输尿管镜下拔除输尿管支架管；记录两组患者一般资料和围术期指标，统计术后结石清除率、术后并发症及患者满意度。结果： 试验组术后第3天清石率为93.02%(40/43)，明显高于对照组的65.00%(26/40)，差异有统计学意义(P=0.002)；术后3天血尿、疼痛、发热比较两组无统计学差异(P＞0.05)，术后4周血尿、疼痛、发热比例对照组明显高于试验组(P均<0.05)；术后3天满意度两组无统计学差异(P＞0.05)，术后4周满意度试验组明显高于对照组(P＜0.01)。结论： FURL联用FVSUAS治疗＞2 cm上尿路结石，术后3天拔除输尿管支架管无管化出院，可取得较高结石清除率，并可明显减少发热、血尿、疼痛并发症的发生,是一种安全有效的治疗方式。

Objective： To investigate the clinical efficacy of flexible ureteroscopic lithotripsy（FURL） using flexible vacuum suction ureteral access sheath (FVSUAS) in the treatment of upper urinary tract calculi >2 cm, through the combination of crushing and suction technology, without indwelling double J tube before discharge. Methods： Clinical data of 43 patients with >2 cm upper urinary tract stones treated with FVSUAS during FURL from January 2022 to October 2023 were collected and compared with 40 randomly selected patients treated with conventional FURL during the same period. The trial group chose to undergo FURL with FVSUAS and was discharged from the hospital with removal of the ureteral stent tubes 3 days after the operation. In the control group, conventional ureteral access sheath (UAS) was used, and ureteral stent tubes were routinely placed in place postoperatively, and the ureteral stent tubes were removed under second-stage cystoscopy/ureteroscopy at 4 weeks; general data and perioperative indices of patients of the two groups were recorded, and the postoperative stonefree rate, postoperative complications, and patient satisfaction were obtained. Results： The stone-free rate on the 3rd postoperative day in the trial group was 93.02% (40/43), which was significantly higher than that in the control group of 65.00% (26/40), and the difference was statistically significant (P=0.002). When haematuria, pain, and fever between the trial group and the control group on the 3rd postoperative day was compared, the difference was not statistically significant (P>0.05); the proportion of haematuria, pain, and fever in the control group at 4 weeks after the surgery was significantly higher than that of the trial group, the difference was statistically significant (all P<0.05, the satisfaction of the trial group at 4 weeks postoperatively was significantly higher than that of the control group (P<0.01). Conclusion： FURL in combination with FVSUAS for the treatment of >2 cm upper urinary tract stones and tubeless discharge with ureteral stent tubes removed 3 days postoperatively achieves high stonefree rate and significantly reduces the incidence of fever, haematuria and pain complications, and it can be concluded that it is a safe and effective treatment modality.