后腹腔镜输尿管切开取石术26例

目的：探讨后腹腔镜输尿管切开取石术的技术要点及临床价值。方法：采用后腹腔镜技术行输尿管切开取石术26例，其中18例分别于术前行体外冲击波碎石术(ESWL)、输尿管镜取石术或两者结合而失败，8例术前未行其他治疗；结石直径12—25mm，平均18．5mm。结果：1例因结石移人肾脏改行开放性手术，余25例取石成功；手术时间40—240min，平均70min；术中出血量10—50ml，平均21．3ml；肠功能恢复时间l2—24h，术后4d拔除腹膜后引流管，无漏尿；术后住院时间5—6d；2l例获随访2—38个月，所有病例肾功能均得到改善，无结石复发及输尿管狭窄发生。结论：后腹腔镜输尿管切开取石术是安全有效的治疗输尿管结石的方法，可部分代替传统开放性手术，对于较大的输尿管上段结石可作为首选的治疗方法。

Retroperitoneoscopic ureterolithotomy (The experience of 26 cases)

Purpose:To review the technical detail of retroperitoneoscopic ureterolithotomy and evaluate its clinical effect.Methods:Between August 2000 and December 2003, retroperitoneoscopic ureterolithotomy was carried out in 18 patients as a salvage procedure after unsuccessful ESWL, ureteroscopy or both, and in 8 patients as a primary procedure. The stone size ranged from 12 mm to 25 mm (mean 18.5 mm) with the incarceration time from 2 months to 12 years.Results:Of all the cases,25 patients underwent retroperitoneoscopic ureterolithotomy successfully, only 1 case converted to operation. the operation time ranged from 40 to 240 minutes (mean 70 minutes), the blood loss ranged from 10 to 50ml (mean 21.3 ml), no leakage of urine occurred . During the follow up period of 21 cases ,there was no ureteric stricture or recurrent calculus had been found,and all patients' renal function had been improved.Conclusions:Retroperitoneoscopic ureterolithotomy is a safe and effective minimally invasive procedure, it can take place of conventional open surgery in part, and in selected patients with large chronically impacted upper ureteric stones, it may be considered as the first-line treatment.