Abstract: Objective The efficacy of percutaneous nephrolithotomy combined with flexible cystoscopy in complicated renal calculi was explored.
Methods We collected 78 patients with complicated stones in our department from June 2018 to June 2019，including 36 patients in the combined group and 42 patients in the percutaneous nephrolithotomy group.All patients were anesthetized by general anesthesia.The intraoperative operative time，hospital stay，intraoperative bleeding，and number of percutaneous nephroscopic channels were compared between the two groups.The stone clearance rate at 5 days and 1 month after surgery，the incidence of stage Ⅱ lithotripsy，and the incidence of perioperative complications were evaluated.
Results The operation was successful in both groups.The average operation time of the combined group was 136.32±12.54min，the average hospitalization time was 7.02±0.84 d，the average intraoperative blood loss was 74.29±7.17 ml，and the incidence of stage Ⅱ lithotripsy was 2.7%（1/36）.The average operation time of percutaneous nephrolithotomy was 120.28±14.62 min，the average hospitalization time was 7.10±0.96 d，the average intraoperative blood loss was 75.23±6.18ml，and the incidence of stage Ⅱlithotripsy was 23.80%（10/42）.The operation time of the combined group was often longer than that of the percutaneous nephrolithotomy group.The incidence of stage Ⅱ lithotripsy was lower than that of the percutaneous nephrolithotomy group，the difference was statistically significant（P<0.05）.There was no difference in hospitalization time，number of percutaneous nephroscopic channels and intraoperative bleeding between the two groups.Statistical significance（P>0.05），The 5d stone clearance rate was 91.7%（33/36）in the combined group，97.2%（35/36）in the postoperative month，and 69.0% in the percutaneous nephrolithotomy./42），the stone clearance rate was 76.2%（32/42）in January，and the difference was statistically significant（P<0.05）.The total complication of the combined group was 16.66%（6/36），and the total complication of the percutaneous nephrolithotomy group was 38.09%（16/42）.The difference between the two groups was statistically significant（P<0.05）.The degree was higher than that in the percutaneous nephrolithotomy group，and the difference was statistically significant（P<0.05）.
Conclusion In the treatment of complex kidney stones，percutaneous nephrolithotomy combined with flexible cystoscopy surgery has good effect and safety，and it is worthy of clinical application.

Key words: flexible cystoscopy, percutaneous nephrolithotomy, complicated renal calculus, holmium laser lithotripsy