目的 探讨局部麻醉下可弯曲负压鞘联合输尿管软镜治疗3.0 cm以上大负荷肾结石的有效性和安全性。 方法 回顾性分析2023年1月至2023年12月于重庆医科大学附属第一医院泌尿外科局麻下完成的输尿管软镜钬激光碎石治疗的3.0 cm以上肾结石患者的临床资料，并分为可弯鞘组和传统鞘组，收集其一般资料，对比2组在围术期指标、术后并发症、手术效果等相关指标的差异。 结果 共96例患者纳入研究，其中可弯曲鞘组44例，传统鞘组52例，2组患者的年龄、体质指数（body mass index，BMI）、结石负荷等一般资料2组间比较差异无统计学意义，可弯鞘组术后清石率（72.73%）明显高于传统鞘组（46.15%），P<0.05，而并发症发生率，如发热（2.27%）、石街形成（2.27%）明显低于传统鞘组（23.08%/17.31%），P<0.05，单次手术时间可弯鞘组［（126.20±21.45） min］与传统鞘组［（116.71±27.39） min］比较差异无统计学意义。 结论 局麻下可弯曲负压鞘联合输尿管软镜治疗≥3 cm肾结石安全、有效，值得推广和应用。

Objective To investigate the efficacy and safety of a tip-flexible suctioning ureteral access sheath combined with a flexible ureteroscope under local anesthesia in the treatment of high-burden kidney stones with a diameter of ≥3 cm. Methods A retrospective analysis was performed for the clinical data of the patients with kidney stones with a diameter of ≥3 cm who underwent holmium laser lithotripsy by ureteral ureteroscopy under local anesthesia in Department of Urology，The First Affiliated Hospital of Chongqing Medical University，from January to December 2023，and the patients were divided into flexible sheath group and conventional sheath group. General data were collected，and the two groups were compared in terms of perioperative indicators，postoperative complications，and surgical outcomes. Results A total of 96 patients were enrolled in this study，with 44 patients in the flexible sheath group and 52 patients in the conventional sheath group. There were no significant differences between the two groups in the general data such as age，body mass index，and stone burden，and compared with the conventional sheath group，the flexible sheath group had a significantly higher postoperative stone clearance rate（72.73% vs. 46.15%，P<0.05），while the complication rates，such as fever（2.27%） and stone street formation（2.27%） were significantly lower than that of the traditional sheath group（23.08%/17.31%），P<0.05，There was no significant difference in the time of single operation between the flexible sheath group and the conventional sheath group（126.20±21.45 min vs. 116.71±27.39 min）. Conclusion Tip-flexible suctioning ureteral access sheath combined with flexible ureteroscopy under local anesthesia is safe and effective in the treatment of high-burden kidney stones with a diameter of ≥3 cm and thus holds promise for clinical application.