后腹腔镜输尿管上段切开取石术的治疗体会（附46例报告）

目的：探讨后腹腔镜输尿管上段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球管上段切开取石术46例，其中有29例有ESWL失败史。结石直径10～25mm，平均17．5mm。结果：46例手术全部成功。手术时间55～160rain，平均100min；术中出血20～60ml，平均30ml；术后无漏尿；肠功能恢复时间12～24h；术后2～3天拔除血浆引流管；术后住院7～8天；随访25例，随访时间6～10个月，患者肾脏积水及肾功能均明显好转，无结石复发、炎性息肉及输尿管切开缝合处狭窄。结论：后腹腔镜输尿管上段切开取石术作为微创泌尿外科的手术方法，丰富了对于输尿管上段结石的治疗手段；其具有创伤小、疼痛轻、恢复快等优点；掌握好手术指征，是治疗输尿管上段结石安全有效的手术方法。

Retroperitoneoscopic Ureterolithotomy for Upper Ureteral Calculi (Report of 46 Cases)

Objective： To evaluate the technical points and clinical role of retroperitoneal Iaparoscopic uret erolithotomy for upper ureteral calculi. Methods：Retroperitoneal laparoscopic ureterolithotomy was performed in 46 patients with upper ureteral calculi, 29 of 46 patients had treated with extracorporeal shock-wave lithotripsy （ESWL） but not succeeded. The diameter of calculi ranged from 10 to 25 ram, mean 17.5 ram. Results：All the 46 patients successfully underwent retroperitoneal laparoscopie ureterolithotomy. The operative time was 55 to 160 min （mean 100 min）, estimated blood loss was 20 to 60 ml （mean 30 ml）. No urine leakage after surgery, and in- testinal function recovery time was 12 24 h. The retroperitoneaI drainage tube was removed at 2 to 3 days after op- eration. The hospital stay ranged from 7 to 8 days. 25 of 46 patients had regular followed up for 6 to 10 months. During follow-up, hydronephrosis and renal function improved obviously, and no recurrent calculi, inflammatory polyp or ureteric stricture developed. Conclusions ： P, etroperitoneal laparoscopic ureterolithotomy for upper ureteral calculi, with advantages of minimal invasive, less pain and quick recovery, is an effective minimally invasive surgi- cal procedure which enriches the alternative treatments for upper ureteral calculi in some suitable patients.