输尿管上段结石的微创手术治疗

目的：探讨输尿管上段结石的治疗方法。方法：回顾性分析输尿管镜下气压弹道碎石(URSL）,后腹腔镜输尿管切开取石(RLU)、经皮肾穿刺取石(PCNL)治疗输尿管上段结石患者的临床资料。其中URSL组25例,RLU组20例。PCNL组9例。结果：URSL组碎石成功18例;7例不成功,其中3例改为开放手术,1例改为后腹腔镜取石。2例行ESWL术,1例仅留置双J管。术后1个月拔管后自行排出。2例并发输尿管穿孔。RLU组取石成功18例,2例滑入肾内,经配合输尿管镜和腹腔镜直视下经皮肾穿刺取石成功,术后15例有伤口漏尿。PCNL组成功9例,无并发症。结论：USRL创伤小。术后恢复快。是治疗输尿管上段结石的较为满意的治疗方法。PCNL创伤小,取石成功率高,在结石靠近肾盂、儿童输尿管上段结石并同侧肾结石和结石以下输尿管狭窄时应优先考虑。但技术难度较大。RLU可作为URSL不成功后的辅助治疗方法。

Treatment of upper ureteral calculi with minimally invasive operation

Objective:To investigate the treatment of upper ureteral calculi.Method:A retrospective analysis was reviewed in 54 cases of upper ureteral calculi, 25 cases were treated by ureteroscopic lithotrispsy(URSL), 20 cases were underwent by retroperitoneal Laparoscopic ureterotomy(RLU), 9 cases were done by percutaneous nephrolithotomy(PCNL).Result:In URSL satisfactory results were obtained in 18 cases, while 7 cases were failure and need reoperation, 3 cases turned to open operation, 1 cases received retroperitoneal Laparoscopic ureterotomy, 2 cases need ESWL(Extracorporeal shockwave lithotripsy), 1 cases detained D-J tube and stones were expelled spontaneously. 2 cases had complications of ureter perforation. 18 cases were successful in RLU, while 2 cases were treated by the combinations of ureteroscope and PCNL under laparoscope because of guliding of stones. 15 cases had leakage of urine in post-operation. All the operations were successful and no complications were observed in 9 cases of patients who were done by PCNL.Conclusion:URSL is of minimal invasion, postoperative early resumption, which has a satisfactory treatment in the upper ureteral calculi. PCNL has advantages of minimal invasive, safe and effective, which should be take into account in advance in some conditions, but the technique is of some difficulty. RLU is the assistant method when upper ureteral calculi lithotrispsy is failure.