后腹腔镜肾盂输尿管切开取石术(附81例报告)

目的　评价后腹腔镜肾盂输尿管切开取石术治疗肾盂及输尿管中上段结石的应用价值。　方法　施行后腹腔镜肾盂输尿管切开取石术 81例 88侧。男 5 1例 ,女 30例。年龄 12～ 6 5岁 ,平均 36岁。结石直径 0 .8～ 3.0cm。左侧 4 1例 ,右侧 33例 ,双侧 7例。其中肾盂结石 11例 ,输尿管上段结石 6 8例 ,中段 2例。 3例为输尿管阴性结石。 2 1例曾行体外冲击波碎石术 (ESWL)或经输尿管镜气压弹道碎石术 (URL)或两者联合治疗 ;1例曾行经皮肾镜取石术 (MPCNL)、1例行URL致输尿管穿孔 ,中转腹腔镜手术。　结果　结石均一次取净。手术时间 30～ 2 10min ,平均 6 5min ;术中出血量 10～ 6 0ml,平均 2 5ml。 30例合并其他泌尿系疾病者术中一并施行后腹腔镜手术治疗。术后住院时间 4～ 10d。 6 0例获随访 1～ 16个月 ,无结石复发。　结论　后腹腔镜肾盂输尿管切开取石术可成为较大、质硬、阴性、慢性嵌顿性肾盂输尿管上段结石 ,尤其在孤立肾时的一线治疗 ;可作为ESWL和腔内治疗失败的补救治疗措施 ;并可同期行腹腔镜手术治疗并发疾病。

Retroperitoneoscopic pyelolithotomy and ureterolithotomy (report of 81 cases)

Objective To assess the clinical value of retroperitoneoscopic pyelolithotomy (RPPL) and retroperitoneoscopic ureterolithotomy (RPUL) in treating renal pelvis or ureteral calculus. Methods A total of 81 patients with renal pelvis or ureteral calculi underwent RPPL and RPUL on 88 sides. Of them 30 were women and 51 were men. Their age ranged from 12 to 65 years (mean,36 years).The calculi were found on left side in 41 cases,on right side in 33,and on both sides in 7.The calculi were 0.8 to 3.0 cm in diameters.Pyelolithiasis occurred in 11 cases,upper ureteral calculi in 68 cases and middle in 2 cases.Of them 3 had radioparent calculi in ureter.In these patients,21 had experienced unsuccessful ESWL,or ureterorenolithotripsy (URL),or both;2 had undergone conversion to retroperitoneoscopic surgery when the procedure failed in minimally invasive percutaneous nephrolithotomy (MPCNL) or perforation occurred during URL. Results All the stones were completely removed by single procedure.The operation time was between 30 and 210 min with a mean of 65 min.The intra-operative mean bleeding volume was 25 ml (range,10 to 60 ml).30 cases with other urinary tract diseases were cured by retroperitoneoscopic surgery at the same time.The hospital stay was from 4 to 10 days.During the follow-up (1 to 16 months) for the 60 cases,no recurrent calculus was found. Conclusions In selected patients with large,hard,radioparent,chronically impacted pelvis or upper ureteral stones,especially in solitary kidney,RPPL and RPUL may be considered as the first-line treatment and as a salvage procedure for failed ESWL and endoscopy.With these procedures the urinary tract complications can be treated concomitantly.