自制通道单孔后腹腔镜输尿管切开取石术的初步应用体会

目的:初步探讨采用自制通道行单孔后腹腔镜输尿管切开取石术的可行性与安全性。方法:分析2011年6月至2012年12月采用自制套管为23例患者行单孔后腹腔镜输尿管切开取石术的临床资料及随访结果。结果:23例手术均顺利完成,无中转开放及中转常规腹腔镜手术。结石直径平均(17±2.4)mm,手术时间平均(112.8±21.6)min,术中出血量平均(34.3±11.3)ml,术中无并发症发生;术后第1天疼痛评分平均(0.5±2.4)分,未应用镇痛剂,术后平均住院(4.4±0.6)d,术后2例出现尿漏,第3天停止,无残留结石及输尿管狭窄患者。结论:单孔腹膜后腹腔镜输尿管切开取石术安全、有效。明确诊断,熟悉后腹膜解剖结构,熟练掌握腹腔镜手术操作技巧,配合自制单孔通道,是成功完成手术的关键。

Initial experience of retroperitoneal laparoscopic single-site ureterolithotomy using self-made port

Objective：To investigate the feasibility and safety of retroperitoneal laparoscopic single-site surgery for ureterolitho- tomy using a self-made port. Methods：The retrospective analysis was made on the clinical data of 23 patients with upper ureteral calculi who underwent retroperitoneal laparoscopic single-site ureterolithotomy by a self-made port from Jun. 2011 to Dec. 2012 and these pa- tients were followed up. Results：Twenty-three cases of surgery were successfully completed without conversion to open or standard lapa- roscopic surgery. The average diameter of the calculus was （ 17 ~ 2.4 ） ram, the mean operative time was （ 112.8 ＋ 21.6 ） min, the mean estimated blood loss was （ 34.3 ＋ 11.3 ） ml, and no major complication occurred during surgery. The post-operative pain score in the first post-operative day was （0.5 ：t： 2.4 ）, therefore, none of these patients received analgesic after surgery. The mean post-operative hospital stay was （4.4 ~ 0.6） d. Two cases had urine leakage after operation, but recovered after the third postoperative day. And there was no recurrent stone or ureteric stricture. Conclusions：The retroperitoneal laparoscopic single-site surgery for ureterolithotomy using self-made port is a safe and effective treatment for ureteral calculi. Definite diagnoses, good understanding of retroperitoneal anatomy, technical proficiency in laparoscopic surgery, improved self-made single-site laparoscopic apparatus, and good care of complications are keys for successful operation.