后腹腔镜治疗输尿管上段结石67例临床分析

目的探讨后腹腔镜技术治疗输尿管上段结石的安全性和可行性。方法 2008年10月至2012年2月我院采用后腹腔镜技术治疗输尿管上段结石病例67例,其中男41例,女26例;年龄21～72岁,平均48岁;左侧40例,右侧27例;结石直径0.9～2.6 cm,平均1.42 cm;以尖刀、切开刀或百克剪切开输尿管,取出结石后放置双J管,用5或4个0号可吸收缝线缝合输尿管1～3针。结果本组共67例,3例因术中病情变化转开放手术;手术时间50～260 min,平均104 min,其中2010年6月之前早期开展手术平均时间154 min,2010年7月至今共开展46例,平均手术时间约81 min;术中出血20～100 ml,平均40 ml;术后3～7 d拔除后腹腔引流管,3～8 d后拔除尿管;术后住院时间4～10 d,平均6 d。2例出现早期漏尿现象,给予继续留置导尿观察均于术后2周内愈合。术后门诊随访10～36个月,均未见结石复发和输尿管狭窄。结论后腹腔镜输尿管切开取石术治疗输尿管上段结石安全、有效,随着操作的熟练和技巧的提高,手术时间会不断缩短。

Retroperitoneal laparoscopic ureterlithotomy,a report of 67 cases

Objective To evaluate the safety and feasibility of ureterolithotomy with retroperitoneal laparoscopic approach. Methods The clinical data of 67 patients with ureteral calculus, who underwent retroperitoneal laparoscopic ureterolithotomy in our hospital from October 2008 to February 2012, were retrospectively analyzed. Results Out of 67 patients 3 were transferred to open operation; 64 were completed with retroperitoneal laparoscopic ureterolithotomy. The mean operation time was 80 rain（50 ~260 min）, and the mean intraoperative bleeding was 40 ml（20 ~ 100 ml）, and the mean postoperative hospital stay was 6 d （ 4 - 10 d）. Patients were followed-up for 10 - 36 months. Postoperative urethral fistula developed in 2 cases, which were healed with 14 days. There was no calculus recurrence and ureteral stricture after operation. Conclusion Laparoscopic ureterolithotomy with retroperitoneal approach is safe and feasible for patients with ureteral calculus.