目的 探讨无输尿管通路鞘+无输尿管支架（简称“无鞘无管”）一期输尿管软镜在治疗长径≤10 mm输尿管上段结石和肾结石中的安全性和可行性。 方法 选取2023年1月至2024年6月在四川大学华西医院广安医院收治的直径≤10 mm的输尿管上段结石或肾结石共计70例，采用随机分配的方式分为“无鞘无管”组（试验组）35例和“有管有鞘”组（对照组）35例，其中试验组不使用输尿管通路鞘和输尿管支架，对照组均使用输尿管通路鞘和输尿管支架。比较2组患者的术前一般资料、术中并发症、结石清除率、住院时间、住院费用和术后并发症等。 结果 2组患者年龄、体质指数（body mass index，BMI）、性别、既往结石手术史、结石患侧、结石最大经、术前C反应蛋白、集合系统分离、术前结石CT值和结石部位等术前一般资料对比差异无统计学意义。试验组的手术时长为（44.94±52.60） min低于对照组的（52.60±14.22） min，差异有统计学意义（t=2.240，P=0.030）。2组患者在术中输尿管损伤、白细胞变化及失血量等方面的比较差异均无统计学意义（均P>0.05）。试验组的住院费用为（8 041.89±1 287.57）元，明显的低于对照组的（13 011.63±1 780.21）元，差异有统计学意义（t=13.450，P=0.000）。试验组与对照组在住院时间、术后1个月CT复查结石复发率、术后3个月CT复查结石复发率、结石清除率、术后尿路刺激症状、术后输尿管损伤、术后血尿及术后肾积水等术后资料对比，差异无统计学意义（均P>0.05）。 结论 “无鞘无管”一期输尿管软镜碎石术在治疗长径≤10 mm输尿管上段结石和肾结石安全可行，有效减少患者住院费用和手术时间。

Objective To investigate the safety and feasibility of one-stage flexible ureteroscopic lithotripsy without ureteral access sheath or ureteral stent in the treatment of upper ureteral calculi and renal calculi with a long diameter of ≤10 mm. Methods A total of 70 patients with upper ureteral calculi or renal calculi with a long diameter of ≤10 mm who were admitted to Guang’an Hospital，West China Hospital of Sichuan University，from January 2023 to June 2024 were enrolled and randomly divided into experimental group （without ureteral access sheath or ureteral stent） and control group （with ureteral access sheath and ureteral stent），with 35 patients in each group. The patients in the experimental group did not use a ureteral access sheath or a ureteral stent，while those in the control group used the ureteral access sheath and the ureteral stent. The two groups were compared in terms of preoperative data，intraoperative complications，stone clearance rate，length of hospital stay，hospital costs，and postoperative complications. Results There were no significant differences between the two groups in preoperative data such as age，body mass index，sex，previous history of stone surgery，affected side，maximum stone diameter，C-reactive protein，aggregation system separation，preoperative CT value of stones，and stone location. The experimental group had a significantly shorter time of operation than the control group［（44.94±52.60） minutes vs. （52.60±14.22） minutes，t=2.240，P=0.030］. There were no significant differences between the two groups in intraoperative data such as ureteral injury，intraoperative leukocyte changes，and intraoperative blood loss. The experimental group had significantly lower hospital costs than the control group［（8041.89±1287.57） yuan vs. （13 011.63±1 780.21） yuan，t=13.450，P=0.000］. There were no significant differences between the experimental group and the control group in the postoperative data such as the length of hospital stay，the recurrence of calculi on CT at 1 and 3 months after surgery，stone clearance rate，postoperative urinary tract irritation，postoperative ureteral injury，postoperative hematuria，and postoperative hydronephrosis（P>0.05）. Conclusion One-stage flexible ureteroscopic lithotripsy without ureteral access sheath or ureteral stent is safe and feasible in the treatment of upper ureteral calculi and renal calculi with a long diameter of ≤10 mm and can effectively reduce hospital costs and time of operation.