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.

Objective： To analyze the clinical efficacy of flexible ureteroscopic holmium laser lithotripsy (FURL) and rigid ureteroscopic holmium laser lithotripsy (RURL) with N-Trap in the treatment of upper ureteral calculi. Methods： A total of 92 cases of upper ureteral calculi with a diameter greater than 10 mm admitted to Shanghai TCM-Integrated Hospital, Shanghai University of Traditional Chinese Medicine from October 2021 to April 2023 were selected as research subjects. The cases were randomly divided into FURL group of 46 cases and RURL group of 46 cases. The FURL group received the operation of FURL, while the RURL group received the operation of RURL with N-Trap. The operation success rate between FURL group and RURL group were compared. The surgical time, severe complications, 1-month stone clearance rate and 3-month stone clearance rate of the successful operation cases between the FURL group and the RURL group were compared. After dividing the two groups of calculi cases into upper FURL group, lower FURL group, and upper RURL group, lower RURL group based on whether the calculus was above the lower pole of the kidney or not, the indexes mentioned above were compared between the two groups in subgroups. Results： The operation success rate of the FURL group (95.7%) was significantly higher than that of the RURL group (80.4%). The operation success rate of the upper FURL group (96.0%) was significantly higher than that of the upper RURL group (70.8%), while there was no significant difference between the lower FURL group (95.2%) and the lower RURL group (90.9%, P>0.05). The indexes of the successful operation cases of the two groups were analyzed as follows. The operation duration of the FURL group, the upper FURL group, and the lower FURL group were longer than those of the RURL group, the upper RURL group, and the lower RURL group respectively (P<0.05). There were no significant differences in the incidence of severe complications between the FURL group, the upper FURL group, the lower FURL group and the RURL group, the upper RURL group, the lower RURL group respectively (P>005). There was no significant difference in 1-month stone clearance rate between the FURL group (84.1%) and the RURL group (67.6%, P>0.05). The 1-month stone clearance rate of the upper FURL group (83.3%) was higher than that of the upper RURL group (52.9%), while there was no significant difference in 1-month stone clearance rate between the lower FURL group (850%) and the lower RURL group (80.0%, P>0.05). There were no significant differences in 3-month stone clearance rate between the FURL group, the upper FURL group, the lower FURL group and the RURL group, the upper RURL group, the lower RURL group respectively (P>0.05). Conclusion： Both FURL and RURL are safe operations in the treatment of upper ureteral calculi. For the upper ureteral calculi above the lower renal pole, the success rate and 1month stone clearance rate are higher with the treatment of FURL than those with the treatment of RURL, it may be implicated that FURL is a better choice than RURL in the treatment of calculi in this segment of upper ureter. For the upper ureteral calculi below the lower renal pole, the success rate and stone clearance rate are similar between FURL and RURL, while the operation time of RURL is shorter than that of FURL.

Objective： To establish a method for identifying melamine in stones by fourier transform infrared spectrometer (FTIR) combined with chemometrics. By preparing in vitro simulated calcium oxalate (CaOx) stones containing melamine, the characteristic group information of melamine was analyzed, and the characteristic response bands of 1 535~1 548 cm-1, 983~997 cm-1 and 704~716 cm-1 were selected for stoichiometric analysis. The training set was established with simulated CaOx stones and human kidney stone samples, and the validation set was established with human kidney stones, and the IR spectra of obtained stone samples were preprocessed by baseline correction, smoothing, vector normalization, secondorder derivation, and standard normal variable transformation. OPUS software and Unscrambler software were used for cluster analysis and principal component analysis of stone samples to identify melamine in human kidney stones. Results： In the training set, the identification rate of melaminecontaining stones was 90.9% by cluster analysis, and 91.8% was identified by principal component analysis. In the validation set, 95.0% of the stones containing melamine were successfully identified. Conclusion： FTIR combined with chemometrics can effectively identify melamine in stones.

目的： 观察经尿道输尿管软镜（flexible ureterorenoscopy，F-URS）联合可弯曲负压吸引输尿管导引鞘（简称负压吸引鞘）治疗复杂性肾结石的安全性和有效性。方法： 回顾性分析2021年6月至2023年6月联勤保障部队第906医院收治的456例复杂性肾结石患者的临床资料。根据手术方法不同分为负压组（n=230）和常规组（n=226）。负压组采用经尿道FURS联合负压吸引鞘治疗，常规组采用经尿道FURS钬激光碎石术治疗。比较两组的手术时间、结石清除率、住院时间、围术期并发症等情况。结果： 456例患者均一期完成手术。负压组230例中，200例顺利置入负压吸引鞘并行F-URS钬激光碎石术，5例输尿管扭曲狭窄改行微创经皮肾镜取石术（mini-percutaneous nephrolithotomy，M-PNL），25例输尿管狭窄改行支架管置入术，待后二期FURS。常规组226例中，188例顺利行F-URS，8例输尿管扭曲狭窄改行MPNL，30例输尿管狭窄改行支架管置入术，待后二期FURS。负压组平均手术时间（71.60±15.60）min，明显少于常规组（102.23±2915）min，差异有统计学意义（P<0.01）；负压组结石清除率为82.50%（165/200），明显高于常规组69.15%（130/188），差异有统计学意义（P<0.01）；负压组围术期尿源性感染率为8.50%（17/200），明显低于常规组25.53%（48/188），差异有统计学意义（P<0.05）；两组患者平均住院天数无统计学差异（P＞0.05）。结论： 与常规经尿道FURS钬激光碎石术对比，经尿道F-URS联合负压吸引鞘治疗复杂性肾结石能缩短手术时间，提高结石清除率，减少手术并发症。