Fluoro-ruby retrograde tracing and three-dimensional visualization of the corticospinal tract in the guinea pig

Fluoro-ruby was injected into the posterior funiculus of the spinal cord in the cervical （C5-T2） and lumbar （L3-6） segments of adult guinea pigs. The spinal cord was cut into serial frozen sections. The Fluoro-ruby labeling was clearly delineated from the surrounding structure. The labeling traversed the cervical, thoracic and lumbar segments, and was located on the ventral portion of the posterior funiculus on the injected side, proximal to the intermediate zone of the dorsal gray matter. The fluorescence area narrowed rostro-caudally. The spinal cord, spinal cord gray matter and corticospinal tract were reconstructed using 3D-DOCTOR 4.0 software, resulting in a robust three-dimensional profile. Using functionality provided by the reconstruction software, free multi-angle observation and sectioning could be conducted on the spinal cord and corticospinal tract. Our experimental findings indicate that the Fluoro-ruby retrograde fluorescent tracing technique can accurately display the anatomical location of corticospinal tract in the guinea pig and that three-dimensional reconstruction software can be used to provide a three-dimensional image of the corticospinal tract.

Endoscopic retrograde cholangiopancreatography in pancreatic and biliary tract disease in Korean children

AIM:To assess the indications,findings,therapeutic procedures,safety,and complications of endoscopic retrograde cholangiopancreatography(ERCP) performed in Korean children.METHODS:The demographic characteristics,indications for ERCP,findings,therapeutic procedures,and complications of 122 pediatric patients who underwent 245 ERCPs in the Asan Medical Center between June 1994 and March 2008 were investigated.RESULTS:The mean age of the 122 patients was 8.0 ± 4.2 years.Indications were biliary pathology in 78(64.0%),pancreatic pathology in 43(35.2%),and chronic abdominal pain in one.Biliary indications included choledochal cysts in 40,choledocholithiasis in 24,suspected sclerosing cholangitis in 8,trauma in 2,and other conditions in 4.Pancreatic indications includedacute pancreatitis in 7,acute recurrent pancreatitis in 11,chronic pancreatitis in 20,trauma in 3,and pancreatic mass in 2.Of the 245 ERCPs,success rate was 98.4% and 190(77.6%) were for therapeutic purposes,including endoscopic nasal drainage(51.8%),biliary sphincterotomy(38.0%),pancreatic sphincterotomy(23.3%),stent insertion(15.1%),stone extraction(18.8%),and balloon dilatation(11.0%).Complications were postERCP pancreatitis in 16(6.5%),ileus in 23(9.4%),hemorrhage in 2(0.8%),perforation in 2(0.8%),sepsis in 1(0.4%),and impacted basket in 1(0.4%).There were no procedure-related deaths,and most complications improved under supportive care.CONCLUSION:This study showed that there is a high incidence of choledochal cyst and diagnostic and therapeutic ERCP for the management of various biliary and pancreatic diseases was safe and effective in Korean children.

Comparison of commonly used retrograde tracers in rat spinal motor neurons

The purpose of this study was to investigate the effect of four fluorescent dyes, True Blue（TB）, Fluoro-Gold（FG）, Fluoro-Ruby（FR）, and 1,1′-dioctadecyl-3,3,3′,3′-tetramethylindocarbocyanine perchlorate（Di I）, in retrograde tracing of rat spinal motor neurons. We transected the muscle branch of the rat femoral nerve and applied each tracer to the proximal stump in single labeling experiments, or combinations of tracers（FG-Di I and TB-Di I） in double labeling experiments. In the single labeling experiments, significantly fewer labeled motor neurons were observed after FR labeling than after TB, FG, or Di I, 3 days after tracer application. By 1 week, there were no significant differences in the number of labeled neurons between the four groups. In the double-labeling experiment, the number of double-labeled neurons in the FG-Di I group was not significantly different from that in the TB-Di I group 1 week after tracer application. Our findings indicate that TB, FG, and Di I have similar labeling efficacies in the retrograde labeling of spinal motor neurons in the rat femoral nerve when used alone. Furthermore, combinations of Di I and TB or FG are similarly effective. Therefore, of the dyes studied, TB, FG and Di I, and combinations of Di I with TB or FG, are the most suitable for retrograde labeling studies of motor neurons in the rat femoral nerve.

A rabies virus-based toolkit for efficient retrograde labeling and monosynaptic tracing

Analyzing the structure and function of the brain's neural network is critical for identifying the working principles of the brain and the mechanisms of brain diseases.Recombinant rabies viral vectors allow for the retrograde labeling of projection neurons and cell type-specific trans-monosynaptic tracing,making these vectors powerful candidates for the dissection of synaptic inputs.Although several attenuated rabies viral vectors have been developed,their application in studies of functional networks is hindered by the long preparation cycle and low yield of these vectors.To overcome these limitations,we developed an improved production system for the rapid rescue and preparation of a high-titer CVS-N2c-ΔG virus.Our results showed that the new CVS-N2c-ΔG-based toolkit performed remarkably:(1)N2cG-coated CVS-N2c-ΔG allowed for efficient retrograde access to projection neurons that were unaddressed by rAAV9-Retro,and the efficiency was six times higher than that of rAAV9-Retro;(2)the trans-monosynaptic efficiency of oG-mediated CVS-N2c-ΔG was 2–3 times higher than that of oG-mediated SAD-B19-ΔG;(3)CVS-N2c-ΔG could delivery modified genes for neural activity monitoring,and the time window during which this was maintained was 3 weeks;and(4)CVS-N2c-ΔG could express sufficient recombinases for efficient transgene recombination.These findings demonstrate that new CVS-N2c-ΔG-based toolkit may serve as a versatile tool for structural and functional studies of neural circuits.

The Double Projecting Neuron of the Cat Spinal Dorsal Horn——A Study with Double Retrograde Fluorescent Tracing Technique

The new double projecting neurons were found in the cat spinal dorsal horn by the double retrograde fluorescent tracing technique.Fast Blue(FB)was injected into unilateral dorsal column nucleus(DCN)of adult cats anesthetized with pentobarbital.Nuclear Yellow(NY)was injected ipsilaterally into the lateral cervical nucleus(LCN)8-9 days later.After an additional 18-30 hrs.

Biotinylated dextran amine anterograde tracing of the canine corticospinal tract

In this study, biotinylated dextran amine （BDA） was microinjected into the left cortical motor area of the canine brain. Fluorescence microscopy results showed that a large amount of BDA-labeled pyramidal cells were visible in the left cortical motor area after injection. In the left medulla oblongata, the BDA-labeled corticospinal tract was evenly distributed, with green fluorescence that had a clear boundary with the surrounding tissue. The BDA-positive corticospinal tract entered into the right lateral funiculus of the spinal cord and descended into the posterior part of the right lateral funiculus, close to the posterior horn, from cervical to sacral segments. There was a small amount of green fluorescence in the sacral segment. The distribution of BDA labeling in the canine central nervous system was consistent with the course of the corticospinal tract. Fluorescence labeling for BDA gradually diminished with time after injection. Our findings indicate that the BDA anterograde tracing technique can be used to visualize the localization and trajectory of the corticospinal tract in the canine central nervous system.

Double-balloon endoscopic retrograde cholangiopancreatography for patients who underwent liver operation: A retrospective study

BACKGROUND Double-balloon endoscopic retrograde cholangiography (DB-ERC) is widely performed for biliary diseases after reconstruction in gastrointestinal surgery,but there are few reports on DB-ERC after hepatectomy or living donor liver transplantation (LDLT).AIM To examine the success rates and safety of DB-ERC after hepatectomy or LDLT METHODS The study was performed retrospectively in 26 patients (45 procedures) who underwent hepatectomy or LDLT (liver operation:LO group) and 40 control patients (59 procedures) who underwent pancreatoduodenectomy (control group).The technical success (endoscope reaching the choledochojejunostomy site),diagnostic success (performance of cholangiography),therapeutic success(completed interventions) and overall success rates,insertion and procedure(completion of DB-ERC) time,and adverse events were compared between these groups.RESULTS There were no significant differences between LO and control groups in the technical [93.3%(42/45) vs 96.6%(57/59),P=0.439],diagnostic [83.3%(35/42) vs83.6%(46/55),P=0.968],therapeutic [97.0%(32/33) vs 97.7%(43/44),P=0.836],and overall [75.6%(34/45) vs 79.7%(47/59),P=0.617] success rates.The median insertion time (22 vs 14 min,P <0.001) and procedure time (43.5 vs 30 min,P=0.033) were significantly longer in the LO group.The incidence of adverse events showed no significant difference [11.1%(5/45) vs 6.8%(4/59),P=0.670].CONCLUSION DB-ERC after liver operation is safe and useful but longer time is required,so should be performed with particular care.

Endoscopic retrograde cholangiopancreatography drainage for palliation of malignant hilar biliary obstruction——stent-in-stent or side-by-side?A systematic review and meta-analysis

BACKGROUND Biliary drainage,either by the stent-in-stent(SIS)or side-by-side(SBS)technique,is often required when treating a malignant hilar biliary obstruction(MHBO).Both methods differ from each other and have distinct advantages.AIM To compare both techniques regarding their efficacy and safety in achieving drainage of MHBO.METHODS A comprehensive search of multiple electronic databases(MEDLINE,Embase,LILACS,BIREME,Cochrane)was conducted and grey literature from their inception until December 2020 with no restrictions regarding the year of publication or language,since there was at least an abstract in English.The included studies compared SIS and SBS techniques through endoscopic retrograde cholangiopancreatography.Outcomes analyzed included technical and clinical success,early and late adverse events(AEs),stent patency,reintervention,and procedure-related mortality.RESULTS Four cohort studies and one randomized controlled trial evaluating a total of 250 patients(127 in the SIS group and 123 in the SBS group)were included in this study.There were no statistically significant differences between the two groups concerning the evaluated outcomes,except for stent patency,which was higher in the SIS compared with the SBS technique[mean difference(d)=33.31;95%confidence interval:9.73 to 56.90,I2=45%,P=0.006].CONCLUSION The SIS method showed superior stent patency when compared to SBS for achieving bilateral drainage in MHBO.Both techniques are equivalent in terms of technical success,clinical success,rates of both early and late AEs,reintervention,and procedure-related mortality.

Biotinylated dextran amine tracing of nerve tracts determines regeneration of corticospinal tracts after neural stem cell transplantation

We investigated regeneration of the corticospinal tract and rearrangement of corticospinal nerves after spinal cord injury by biotinylated dextran amine （BDA） nerve tract tracing after neural stem cell transplantation. Neural stem cell transplantation increased motor function scores of rats at 3 weeks after spinal cord transection injury at the thoracic 10 segment. A proportion of BDA-labeled corticospinal tract regenerated through the spinal cord injury site at 12 weeks after transplantation. Electron microscopy revealed that the regenerated BDA-labeled nerve terminals formed new synaptic connections with neurons at the distal end of the injured site. These findings indicate that BDA nerve tract tracing effectively provides anatomic and morphological evidence of recovery after spinal cord injury.

Visualizing Wallerian degeneration in the corticospinal tract after sensorimotor cortex ischemia in mice

Stroke can cause Wallerian degeneration in regions outside of the brain,particularly in the corticospinal tract.To investigate the fate of major glial cells and axons within affected areas of the corticospinal tract following stroke,we induced photochemical infarction of the sensorimotor cortex leading to Wallerian degeneration along the full extent of the corticospinal tract.We first used a routine,sensitive marker of axonal injury,amyloid precursor protein,to examine Wallerian degeneration of the corticospinal tract.An antibody to amyloid precursor protein mapped exclusively to proximal axonal segments within the ischemic cortex,with no positive signal in distal parts of the corticospinal tract,at all time points.To improve visualization of Wallerian degeneration,we next utilized an orthograde virus that expresses green fluorescent protein to label the corticospinal tract and then quantitatively evaluated green fluorescent protein-expressing axons.Using this approach,we found that axonal degeneration began on day 3 post-stroke and was almost complete by 7 days after stroke.In addition,microglia mobilized and activated early,from day 7 after stroke,but did not maintain a phagocytic state over time.Meanwhile,astrocytes showed relatively delayed mobilization and a moderate response to Wallerian degeneration.Moreover,no anterograde degeneration of spinal anterior horn cells was observed in response to Wallerian degeneration of the corticospinal tract.In conclusion,our data provide evidence for dynamic,pathogenic spatiotemporal changes in major cellular components of the corticospinal tract during Wallerian degeneration.

Diffusion tensor imaging for tracing the corticospinal tract

Totally three articles focusing on magnetic resonance diffusion tensor imaging and diffusion tensor imaging evaluation of ischemic and hemorrhagic stroke, deep brain tumors and healthy corticospinal tract state are published in three issues. We hope that our readers find these papers useful to their research.

Correlation of serum trace element changes with inflammatory cytokines and oxidative stress indexes in patients with urinary tract infection

Objective: To study the correlation of serum trace element changes with inflammatory cytokines and oxidative stress indexes in patients with urinary tract infection (UTI). Methods: The patients who were diagnosed with lower urinary tract infection in our hospital between March 2013 and December 2017 were selected as the UTI group and the healthy volunteers who received physical examination were selected as the control group. Serum was collected to measure the contents of trace elements and inflammatory cytokines, and urine was collected to measure the contents of oxidative stress indexes. Results: The content of Zinc (Zn) in serum of the UTI group was significantly lower than that of the control group (P<0.05) while the contents of Copper (Cu), Selenium (Se), Calcium (Ca) and Magnesium (Mg) were not significantly different from those of the control group (P>0.05);the contents of C-reactive protein (CRP), amyloid protein A (SAA), procalcitonin (PCT), intercellular adhesion molecule-1 (ICAM-1), interleukin-2 (IL-2), interleukin-4 (IL-4), interleukin-5(IL-5), interleukin-17(IL-17) and transforming growth factor-β1 (TGF-β1) in serum as well as the contents of malondialdehyde (MDA) and advanced oxidation protein product (AOPP) in urine of the UTI group were significantly higher than those of the control group and negatively correlated with the content of Zn in serum (r=-0.514, -0.573, -0.475, -0.636, -0.612, -0.585,-0.492, -0.537, -0.611, -0.476 and -0.542, p=0.015, 0.011, 0.024, 0.007, 0.009, 0.010, 0.020, 0.014, 0.009, 0.024 and 0.013) while the contents of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase (CAT) in urine were significantly lower than those of the control group and positively correlated with the content of Zn in serum (r=0.592, 0.657 and 0.610, p=0.010, 0.002 and 0.009). Conclusion: Serum trace element Zn significantly decreases in patients with urinary tract infection and it is closely related to the occurrence of disease as well as the abnormality of inflammation, immune response and oxidative stress in the course of the disease.

Brain-wide N2cG compensation permits glycoprotein-deleted rabies virus to trace neural circuits across multiple synapses

Rabies-viruses-based retrograde tracers can spread across multiple synapses in a retrograde direction in the nervous system of rodents and primates,making them powerful tools for determining the structure and function of the complicated neural circuits of the brain.However,they have some limitations,such as posing high risks to human health and the inability to retrograde trans-synaptic label inputs from genetically-de¯ned starter neurons.Here,we established a new retrograde trans-multi-synaptic tracing method through brain-wide rabies virus glycoprotein(RVG)compensation,followed by glycoprotein-deleted rabies virus(RV-△G)infection in specific brain regions.Furthermore,in combination with the avian tumor virus receptor A(TVA)controlled by a cell-type-specific promoter,we found that EnvA-pseudotyped RV-△G can mediate e±cient retrograde trans-multi-synaptic transduction from cell-type-specific starter neurons.This study provides new alternative methods for neuroscience researchers to analyze the input neural networks of rodents and nonhuman primates.

Who needs further evaluations to diagnose upper urinary tract urothelial cancers among patients with abnormal findings by enhanced CT?

Objective:We evaluated who would need further evaluations such as retrograde pyelography(RP)and/or ureteroscopy to diagnose upper urinary tract urothelial cancers(UUTUCs)when abnormal findings for the upper urinary tract(UUT)were detected by enhanced computed tomography(CT).Methods:We retrospectively analyzed 125 patients who underwent enhanced CT for various reasons and had abnormal findings for the UUT.Patients whose tumors were suspected to be of extraureteral origin were excluded.All patients received RP and/or ureteroscopy to evaluate the UUTUCs.Results:The median age of the 125 patients was 70 years and gross hematuria(26.4%)was the most frequently observed symptoms.RP,ureteroscopy and both were performed for 121,59 and 55 patients,respectively.CT revealed tumor-like lesions in 58 patients and the other patients had non-tumor-like lesions.UUTUCs were found in 43(34.4%)of the 125 patients.All of them had tumor-like lesions on CT.In 58 patients who had tumor-like lesions on CT,univariate and multivariate analyses revealed that tumor diameter and tumor enhancement were significant predictive factors for UUTUCs.ROC curve analysis of enhanced CT to diagnose UUTUCs revealed that a tumor diameter of 18 mm was the best cutoff point.The sensitivity,specificity and accuracy were 90.0%,98.8% and 92.7% for RP and 95.5%,100% and 97.1%for ureteroscopy,respectively.Both of them had high sensitivity,specificity and accuracy.Conclusion:We should decide to evaluate the UUT according to the tumor diameter on enhanced CT.When we evaluate the UUT in patients with tumor diameters of less than 20 mm,ureteroscopy is recommended.

胆总管结石患者ERCP术后早期胆道感染的动态预测工具开发及验证

目的开发胆总管结石患者经内镜逆行性胰胆管造影术(ERCP)后发生早期胆道感染(PEEBI)的预测工具,以期辅助临床进行ERCP术前决策和术后早期个性化干预。方法采用观察性双向队列研究方法,选取某医院接受ERCP的胆总管结石住院患者,分别采用有向无环图(DAGs)和最小绝对收缩与选择算子法(LASSO)进行基于logistic回归的PEEBI预测,比较预测模型,并进行内外部验证。结果2020年1月1日—2023年9月30日,共纳入接受ERCP的胆总管结石患者2121例,其中77例(3.6%)发生了PEEBI,且主要集中在术后前2天(66.2%)。影响PEEBI的主要因素为非医源的患者相关因素,即糖尿病(OR=2.43,95%CI:1.14~4.85)、胆管恶性肿瘤(OR=3.95,95%CI:1.74~8.31)和十二指肠乳头憩室(OR=4.39,95%CI:1.86~9.52)。DAGs模型较LASSO模型的综合判别能力高3.0%(P=0.007),且DAGs模型外部验证中的区分性能(D=0.133,P=0.894)和校准性能(χ^(2)=5.499,P=0.703)均表现良好。结论本研究构建的DAGs模型具有良好的预测性能,临床可在该工具的协助下采取针对性的围手术期早期预防措施,以减少PEEBI的发生。

探寻大脑的奥秘:神经示踪技术的发展与应用

为了深刻理解神经示踪技术,综述了其演进历程、原理、应用及其在神经科学和其他领域中的应用价值和局限.首先,回顾了传统的神经示踪技术,以肽类标志物、传统染料等为例,分析了顺行和逆行标记2种方法.然后,介绍了用于示踪神经环路的病毒工具的最新进展,包括狂犬病毒、伪狂犬病毒、单纯孢疹病毒、腺相关病毒等,揭示了其如何帮助理解大脑复杂的工作机制,探讨了其演化历史、类型以及在大脑科学和神经环路研究中的应用价值.最后,展望了神经环路示踪技术在脑连接组学、人类疾病研究和药物开发等领域的发展前景.这些技术的创新将有助于更深入地理解大脑的奥秘,改善神经健康,并应对神经相关疾病的挑战.

蓝激光前列腺汽化切除术对良性前列腺增生患者术后性功能及下尿路症状的影响

目的分析蓝激光前列腺汽化切除术治疗良性前列腺增生(BPH)的临床效果及对患者术后性功能及下尿路症状(LUTS)的影响。方法回顾性分析2023年3—8月在泰安市中心医院迎胜院区泌尿肾病激光治疗中心接受手术治疗的91例BPH患者的临床资料,根据不同手术方式分为两组,蓝激光组(n=46)采用经尿道蓝激光前列腺汽化切除术,PKRP组(n=45)采用经尿道前列腺等离子电切术(PKRP)。比较两组患者的手术时间、膀胱冲洗时间、留置尿管时间、住院时间,术前、术后6个月的残余尿量(PVR)、最大尿流率(Qmax)、国际前列腺症状评分(IPSS)、生活质量评分(QoL)、国际勃起功能指数-5(IIEF-5)问卷、射精功能评分量表(CIPE)评分以及逆行射精发生率。结果两组手术时间[(24.66±5.38)min vs.(62.50±3.85)min]、膀胱冲洗时间[(20.40±2.78)h vs.(51.93±5.02)h]、留置尿管时间[(1.65±0.89)d vs.(6.73±2.98)d]及住院时间[(4.26±1.57)d vs.(8.45±2.28)d]比较,蓝激光组均明显短于PKRP组(P<0.05)。两组患者术前及术后6个月Qmax、PVR、QoL及IPSS比较差异无统计学意义(P>0.05)。术后6个月蓝激光组较PKRP组的IIEF-5问卷[(20.02±2.63)分vs.(17.64±1.75)分]及CIPE评分更高[(30.88±3.45)分vs.(26.25±3.51)分],差异具有统计学意义(P<0.05)。蓝激光组术后6个月的逆行射精发生率低于PKRP组(4.35%vs.35.60%,P<0.05)。结论蓝激光前列腺汽化切除术能够改善BPH患者LUTS,并且更好的保护了患者的性功能。

Rabies Virus Pseudotyped with CVS-N2C Glycoprotein as a Powerful Tool for Retrograde Neuronal Network Tracing

Efficient viral vectors for mapping and manipulating long-projection neuronal circuits are crucial in structural and functional studies of the brain. The SAD strain rabies virus with the glycoprotein gene deleted pseudotyped with the N2 C glycoprotein(SAD-RV(DG)-N2 C(G)) shows strong neuro-tropism in cell culture, but its in vivo efficiency for retrograde gene transduction and neuro-tropism have not been systematically characterized.We compared these features in different mouse brain regions for SAD-RV-N2 C(G) and two other widely-used retrograde tracers, SAD-RV(DG)-B19(G) and r AAV2-retro. We found that SAD-RV(DG)-N2 C(G) enhanced the infection efficiency of long-projecting neurons by^10 times but with very similar neuro-tropism, compared with SAD-RV(DG)-B19(G). On the other hand, SAD-RV(DG)-N2 C(G) had an infection efficiency comparable with r AAV2-retro, but a more restricted diffusion range, and broader tropism to different types and regions of longprojecting neuronal populations. These results demonstrate that SAD-RV(DG)-N2 C(G) can serve as an effective retrograde vector for studying neuronal circuits.

艾灸联合索利那新对输尿管软镜碎石术后双J管相关并发症的影响

目的:探讨艾灸与索利那新联合应用治疗输尿管软境碎石术后双J管相关并发症及附管结石的临床效果。方法:将100例输尿管软境碎石术后置入双J管的上尿路结石患者随机分为对照组(50例)和观察组(50例)。两组患者均给予常规护理及抗感染、镇痛等对症治疗。对照组患者术后第1天开始给予索利那新口服治疗,观察组在此基础上加以对关元和气海进行艾灸。记录并评估治疗前、第1个疗程结束后、第2个疗程结束后3个时间节点两组患者USSQ评分表中6个部分的评分变化,输尿管软境碎石术术后4周,对拔除双J管后的结石清除率、附管结石的总有效率、尿路感染和血尿情况进行比较。结果:第2个疗程结束后,与治疗前比较,两组患者排尿症状、疼痛、整体健康情况、工作表现评分均降低(P<0.05)。第1、2个疗程结束后,与对照组比较,观察组患者排尿症状、疼痛、整体健康情况评分、工作表现均降低(P<0.05)。观察组患者结石清除率、附管结石的总有效率高于对照组(P<0.05)。结论:艾灸联合索利那新治疗输尿管软境碎石术后双J管相关症状及双J管附管结石形成疗效显著,安全性好,无不良反应。

头端可弯曲负压吸引鞘、常规鞘输尿管软镜手术与经皮肾镜治疗>2 cm上尿路结石的疗效比较

目的 探究头端可弯曲负压吸引鞘肾内逆行手术(RIRS)治疗>2 cm上尿路结石的疗效与安全性,为此类疾病的诊治提供参考。方法 回顾性分析2022年11月—2023年11月于陕西中医药大学第二附属医院行上尿路结石手术的155例患者的资料,根据手术方式将患者分为经皮肾镜碎石取石术(PCNL)组(54例)、常规鞘RIRS组(41例)和可弯鞘RIRS组(60例),比较3组患者的一般及临床资料。结果 术前PCNL组较常规鞘RIRS组和可弯鞘RIRS组的重度肾积水患者占比更高(22.22%vs. 4.88%vs.5.00%,P=0.027)、累及肾下盏的肾盂漏斗夹角(IPA)更小[(36.17±17.6)°vs.(48.57±17.56)°vs.(47.41±10.82)°,P=0.014]。术后3 d PCNL组、常规鞘RIRS组和可弯鞘RIRS组患者的结石清除率(SFR)分别为90.74%、53.66%和78.33%(P<0.05);术后1个月的SFR分别为92.59%、73.17%、81.67%,术后1个月PCNL组与可弯鞘RIRS组的SFR比较差异无统计学意义(P>0.05),但高于常规鞘RIRS组(P<0.05)。PCNL组较常规鞘RIRS组和可弯鞘RIRS组手术时间更短[(65.22±17.67)min vs.(91.73±20.57)min vs.(94.38±24.75)min,P<0.001],术后住院时间更长[5.0(4.0,7.0)d vs. 3.0(2.0,4.0)d vs.3.0(2.0,4.0) d,P<0.001]、血红蛋白下降值更大[(18.00±5.78)g/L vs.(5.57±5.16)g/L vs.(7.42±5.09)g/L,P<0.001]、视觉模拟评分(VAS)更高[(4.83±1.48)分vs.(2.95±1.07)分vs.(3.05±1.21)分,P<0.001],而常规鞘RIRS组和可弯鞘RIRS组间差异无统计学意义(P>0.05)。同时,可弯鞘RIRS组花费少于常规鞘RIRS组而多于PCNL组[(23 311.19±1 341.20)元vs.(24 550.49±1 172.51)元vs.(15 351.97±1 101.4)元,P<0.001]。3组的总体并发症发生率比较差异无统计学意义,其中3例“石街”患者均来自常规鞘RIRS组。结论 对于>2 cm的上尿路结石患者,RIRS比PCNL术后住院时间、血红蛋白下降值更小,VAS评分更低。可弯鞘RIRS术后早期SFR优于常规鞘RIRS,术后1月SFR与PCNL相当,且“石街”发生率低。