Abstract: ［Abstract］ Objective To explore the safety and effectiveness of establishing a percutaneous renal access by one?step expansion. Methods 368 cases who underwent percutaneous nephrolithotomy from January 2014 to October 2017 in our hospital were retrospectively analyzed. According to the different ways of channel establishment, 188 cases were treated by F6?F18 fascia dilator for standard tract percutaneous nephrolithotomy procedure（control group）, and another 180 cases were treated by F18 or F20 fascia dilator by one?step renal access establishment （one?step group）. The establishment time of channel, operation time, blood loss, average length of stay, complications, one?time rate of clear stone were recorded in two groups and were compared between the two groups. Results 368 patients were successfully established channel to complete the operation. The patients in one?step expansion group had shorter establishment time of the channel, higher primary stone clearance rate, less bleeding, as compared to those in control group（all P values were less than 0.05）. There was no significant differences in average length of stay and complication between the two groups （P>0.05）. Conclusion One?step expansion method to establish percutaneous renal access to the treatment of upper urinary tract stones is safe and reliable, which can significantly shorten the non?lithotripsy time of the surgical procedure, and increase the one?time clear stone ratio.

Key words: percutaneous nephrolithotomy, B?positioning, one?step expansion, percutaneous renal access expansion

摘要： ［摘要］目地探讨一步扩张法建立经皮肾通道的安全性及有效性。方法 选择我院2014年1月~2017年10月368例上尿路结石采用经皮肾镜碎石取石的患者资料进行回顾性研究。根据通道建立方式不同进行分组，其中采用F6~F18筋膜扩张器序列扩张法的188例；采用F18或F20号筋膜扩张器直接一步扩张法的180例。比较两组通道建立时间、手术时间、手术出血量、平均住院日、并发症发生率、一次性清石率及并发症发生率情况等方面的差异。结果 368例患者均成功建立通道，完成手术。一步扩张组与序列扩张组比较，通道建立时间明显缩短（P<0.05），一次性清石比率明显增高（P<0.05），出血量明显减少（P<0.05），手术时间缩短（P<0.05），但二者在平均住院日及并发症发生率上无明显差别（P>0.05）。结论 一步扩张法建立经皮肾通道治疗上尿路结石安全可靠，能明显缩短手术过程的非碎石时间，增加一次性清石比率。

关键词: 经皮肾镜取石, B 超定位, 一步扩张法, 经皮肾通道扩张