经腹入路两种途径行腹腔镜下左侧输尿管切开取石术在学习初期的比较

目的对经验不足的外科医生,比较腹腔镜下经腹入路肠系膜间途径行输尿管切开取石术与传统经腹入路侧结肠途径行输尿管切开取石术的疗效。方法回顾性分析郑州大学附属洛阳中心医院在2014年3月至2018年3月期间收治的59例左侧肾盂输尿管连接部狭窄患者的资料,采用常规侧结肠入路32例,而经中结肠系膜间入路27例,比较围手术期结果和随访资料,比较两种方法患者的手术时间、术中失血量、术后肠道功能恢复,术后疼痛程度等情况。结果经中结肠入路组手术时间明显短于常规侧结肠入路组(P<0.05),经中结肠系膜间入路组术后疼痛明显减轻,两组患者在术中失血量、术后进食时间、住院时间等方面差异均无统计学意义(P>0.05)。结论通过中结肠系膜间途径直接暴露输尿管可节省游离侧结肠所需时间。该方法对于经验有限的外科医生也是安全可行的,并具有与侧结肠手术相似的成功率。

Comparison of laparoscopic left ureterolithotomy between the middle colon and the lateral colon in the early stage of learning

Objective To compare the efficacy of laparoscopic ureterolithotomy via the mid-colon approach and laparoscopic ureterolithotomy via the traditional lateral colon approach for inexperienced surgeons.Methods The data of 59 patients with left ureteropelvic junction stenosis admitted to Luoyang central hospital affiliated to Zhengzhou university from March 2014 to March 2018 were retrospectively analyzed.Thirty-two patients were treated by conventional lateral colon approach and 27 patients were treated by mesocolon approach.The perioperative results and follow-up data were compared between the two approaches.The operative time,intraoperative blood loss,postoperative intestinal function recovery,postoperative pain and so on were compared between the two groups.Results The operation time of the middle colon approach group was significantly shorter than that of the conventional side colon approach group(P<0.05).The pain of the middle colon mesocolon approach group was significantly relieved.There was no significant difference in blood loss,feeding time and hospitalization time between the two groups(P>0.05).Conclusions The mesocolon approach is straight through the middle colon.Exposure to ureter can save the time needed for the free colon.Even for surgeons with limited experience,this method is safe and feasible,and has the same success rate as traditional lateral colon surgery.