经腹腹腔镜治疗输尿管下段结石35例临床分析

目的总结腹腔镜治疗输尿管下段结石的经验。方法输尿管下段嵌顿性结石患者35例,左侧16例,右侧19例,单侧输尿管多发性结石2例,结石最大直径1.3~2.5 cm,平均直径(1.85±0.50)cm,均采用经腹腔途径完成腹腔镜输尿管切开取术,术中留置输尿管支架管及手术部位引流管,其中5例输尿管下段狭窄,取石并切除狭窄段后施行输尿管膀胱再接术。结果35例输尿管下段结石经腹腹腔镜切开取石和5例兼行输尿管膀胱再植术,全部成功,效果满意。手术时间30~130分钟,平均(65.30±28.14)分钟,术中出血量10~150 ml,平均(40.57±26.51)ml,术后住院时间5~10天,平均(6.92±1.15)天。术后引流管拔除时间2~4天,平均(3.80±1.33)天。术中均未见肠管及邻近脏器损伤,术后未发生感染、漏尿,输尿管膀胱再植术者未出现输尿管反流和输尿管下段再狭窄。结论经腹腔入路腹腔镜输尿管下段切开取石术,结石取净率高,创伤小,恢复快。     

后腹腔镜输尿管切开取石术与微通道经皮肾镜取石术处理嵌顿性输尿管上段结石的效果

目的比较后腹腔镜输尿管切开取石术(RLUL)与微通道经皮肾镜取石术(mPCNL)处理嵌顿性输尿管上段结石的效果及对患者肾功能的影响。方法回顾性分析2016年1月至2019年12月我科收治的54例嵌顿性输尿管上段结石行手术治疗患者的临床资料,26例行RLUL治疗(A组),28例行mPCNL治疗(B组),比较两组的治疗效果。结果A组的拔引流管时间、拔尿管时间早于B组,术后24 h HGB下降值小于B组,手术时间长于B组,出血量少于B组(P<0.05)。术后1 d,B组的肌酐水平显著高于术前(P<0.05)。术后1个月,A组的胱抑素C、Ccr好转率高于B组(P<0.05)。结论与mPCNL相比,RLUL治疗嵌顿性输尿管上段结石具有出血少、术后恢复快、对肾功能损伤小、利于术后肾功能恢复等优点。     

后腹腔镜输尿管切开取石术在嵌顿性结石中的应用（附58例报告）

目的：探讨后腹腔镜输尿管切开取石术治疗嵌顿性输尿管结石的临床价值和技术要点。方法：2006年12月至2009年3月,对58例嵌顿性输尿管中上段结石采用后腹腔镜输尿管切开取石术,术中取石后于镜下直接置入双J管,间段缝合输尿管切口。结果：58例手术均获成功,无中转开放手术,结石清除率100%。术后创腔引流液量少,3～5d拔除引流管,1周出院,术后3周膀胱镜下拔除双J管。随访1～27个月,B超复查显示肾积水明显好转或消失,无结石复发。结论：后腹腔镜输尿管切开取石术治疗嵌顿性输尿管结石具有创伤小／疗效好、术后恢复快等特点,明显优于开放手术及其它手术,值得推广应用。     

后腹腔镜与开放手术行输尿管上段切开取石术的疗效比较（附62例报告）

目的比较和评价后腹腔镜与开放手术行输尿管上段切开取石术的临床价值。方法回顾性分析后腹腔镜输尿管上段切开取石术（腔镜组）及开放手术行输尿管上段切开取石术（开放组）的临床资料,就两组手术的手术时间、术中出血量、术后下床活动时间、术后住院时间、住院费用及术后并发症发生率进行比较。结果腔镜组术中出血量、术后下床活动时间、术后住院时间及术后并发症发生率优于开放手术组,差异有统计学意义（P〈0.05）;两组在手术时间、住院总费用方面的差异无统计学意义（P〉0.05）。结论后腹腔镜输尿管上段切开取石术损伤小、安全有效、恢复快,具有良好的临床应用前景。     

嵌顿性输尿管上段结石的两种微创治疗方法对比研究

目的探讨嵌顿性输尿管上段结石的微创治疗方法选择。方法将82例嵌顿性输尿管上段结石随机分成两组,每组41例,分别行后腹腔镜输尿管切开取石术和微创经皮肾镜取石术治疗,比较两组结石清除率、并发症发生情况以及相关的临床资料。站呆所有患者均耐受手术,无严重并发症发生。经皮肾镜组和腹腔镜组两组结石清除率分别为95．12％和97．56％,两组结石清除率、术后住院时间、术中出血没有显著性差异’（P〉o．05）。经皮肾镜组和腹腔镜组术后平均出血量分别为（88．10±95．44）mL和（23．90±10．48）mL,并发症发生率分别为19．51％和4．88％,其差异有统计学意义（P〈O．05）。结论两种方法治疗嵌顿性输尿管上段结石都是有效的微创治疗策略,经皮肾镜组术后并发症显著高于腹腔镜组,后腹腔镜输尿管切开取石术安全性高于微创经皮肾镜取石术。     

输尿管上段嵌顿结石治疗决策的比较

目的通过分析体外冲击波碎石(ESWL)、输尿管镜取石(URS)、经皮肾镜取石术(PCNL)、输尿管切开取石术四种治疗方法在输尿管上段嵌顿性结石治疗中的疗效,探讨治疗上段输尿管结石的最佳方法。方法分析了524例临床资料,根据四种不同决策对输尿管上段嵌顿结石的治疗,分别从手术方法、手术成功率、结石取净率、并发症、平均住院天数等多方面进行了比较。结果 URS手术成功率达92.62%(301/325),结石取净率87.08%(283/325),24(7.38%)例改行其它手术(15例PCNL,9例开放取石);PCNL手术Ⅰ期成功率94.69%(103/113),6例改Ⅱ期手术全部成功,结石取净率92.92%(105/113),4例(3.54%)改开放手术;开放取石23例(10+9+4)全部成功。ESWL碎石效果差,成功率仅30.23%(26/86),多需改行URS或PCNL治疗,但ESWL可作为处理URS或PCNL后的残留结石有效手段。URS组出现输尿管穿孔3例(0.92%),PCNL组出现大量冲洗液外漏2例(1.77%)输尿管穿孔2例(1.77%),对症处理后均痊愈。余病例无严重并发症发生。结论对于输尿管上段嵌顿性...     

Laparoscopic ureterolithotomy: Its role and some controversial technical considerations

OBJECTIVE: To define the role of laparoscopic ureterolithotomy in the management of urolithiasis and evaluate the controversial techniques of this operation. METHODS: Between July 1997 and December 2004, retroperitoneoscopic ureterolithotomy was performed as a primary procedure in 30 patients who had either large or impacted stones in the upper ureter. The other indications were stones which could not be fragmented by shock wave lithotripsy or the patients could not afford the cost of shock wave lithotripsy. The mean (range) age of the patients was 44.07 years (17-78) and the mean (range) stone size was 19.03 mm (10-40). The ureter was closed with intracorporeal laparoscopic suture without placing a stent. RESULTS: The stone was removed in all but one case. The mean (range) operative time was 121.38 min (75-270). No intraoperative complications were recorded. The mean (range) postoperative drain removal was 2.86 days (2-10). Postoperative complications included prolonged urinary leakage in one patient. On the sixth month of follow up, all patients were stone free without any evidence of ureteral stricture. CONCLUSION: Laparoscopic ureterolithotomy is a minimally invasive treatment and may be considered as the useful first-line management for large impacted upper ureteric stones. The technical recommendations were retroperitoneal access and suturing the ureterotomy incision. Ureteral stent should be placed in only cases of severe inflammation of the ureter or inappropriate suturing.     

B超引导下经皮输尿管取石12例报告

目的探讨B超引导下经皮输尿管取石的疗效。方法让患者取健侧卧位，在B超引导下经皮肾穿刺造瘘，并将通道扩张到F16～18，从通道插入输尿管镜到结石部位，将结石击碎后取出。结果本组12例输尿管结石中，1例因出血较多改行Ⅱ期取石术，其余11例均Ⅰ期取石成功。结论该手术创伤小、恢复快，适宜于输尿管上段结石伴有不同程度的肾积水患者。     

腹腔镜输尿管切开取石术17例体会

目的探讨腹腔镜输尿管切开取石术的效果。方法腹腔镜输尿管切开取石术17例,平均40岁,结石直径12～30mm,根据X线定位,采用经腹膜后腔和腹腔途径,显露输尿管,用自制刀及电凝钩切开输尿管取出结石。置入双J管,缝合切口。结果17例手术均获成功。随访3～9个月无并发症发生。结论腹腔镜输尿管切开取石术疗效好,患者术后恢复快。