腹腔镜治疗输尿管结石分析

目的:探讨经腹腔后途径腹腔镜输尿管结石切开取石术的疗效及适应证、手术技巧和临床价值.方法:回顾性分析我院经腹腔后途径腹腔镜治疗输尿管上段结石43例临床资料.结果:43例手术均获成功,手术时间40～180min,平均85 min;术中出血量25～175 mL,平均80 mL;肠道功能恢复时间9～27 h.术后发生尿漏6例,负压吸引管引流24 h后愈合拔管,术后5 d拔出导尿管,住院时间4～14d,平均7d,35例术后21d拔出双J管,6例尿漏者术后2个月拔出双J管,43例患者出院后随诊3～24个月,B超及静脉尿路造影(IVU)检查证实无明显输尿管切口处狭窄.患侧肾功能与术前对比有明显改善,左侧输尿管上段结石23例,右侧20例,对比两侧未发现对手术时间有明显影响.结论:经腹腔后途径腹腔镜输尿管切开取石术可以替代部分传统开放手术,具有微创的优点,可作为体外冲击波碎石术(ESWL)或输尿管镜(URL)治疗输尿管结石失败的补救措施,对于较大的输尿管结石可作为首选的治疗方法.

Analysis of laparoscope for treating ureteral stones

Objective：To report the experiences of retroperitoneal laparoscopic ureterolithotomy in our hospital and to study its indications,surgical techniques and clinical value.Methods：The clinical data of 43 cases of upper urethral calculi in our hospital were analyzed and summarized.Results：43 cases were operatively successful,operative time was 40-180 min,average 85min;blood loss 25175mL,average 80mL.The time of intestinal function recovery was 9-27h.Postoperative urinary leakage occurred in 6 cases.The drainage with negative suction lasted for 24 h.After healing,extubation was conducted.After 5 d of operation,the catheter was pulled out.The hospitalization length was 4-14d,average 7d.Duble-J tube was pulled out on postoperative 21d in 35 cases,and after 2 months in 6 cases of urinary leakage.43 patients after discharge from hospital were followed up for 3-24 months.B ultrasound and intravenous urography（IVU） examination confirmed no significant ureteral incision stricture.The renal function in the affected side significantly improved compared with preoperation.There were left upper ureteral stones in 23 cases and right in 20 cases.Contrasting both sides had no significant effect on the operation time.Conclusion：Retroperitoneal laparoscopic ureterolithotomy can replace some of the traditional open surgery with the advantages of minimal invasion,particularly which can be used as a remedial measure of extracorporeal shock wave lithotripsy（ESWL） or ureteroscopy（URL） failure for treating ureteral stones.It can be used as the preferred method of treatment for larger ureteral stones.