单孔腹腔镜输尿管切开取石术的初步应用体会

目的 探讨经腹膜后途径,行单孔腹腔镜输尿管切开取石术的可行性及疗效.方法 2010年6月至2011年2月,收治8例单侧输尿管上段结石患者,采用自制多通道套管,经腹膜后途经,行单孔腹腔镜输尿管切开取石术.以同一术者完成的15例传统腹腔镜经腹膜后输尿管切开取石术作为对照组.对比两组的手术时间、出血量、手术并发症、平均住院时间、术后镇痛药应用时间及腹膜后引流管停留时间等指标.结果 所有单孔腹腔镜手术均获成功、无1例转为传统腹腔镜或开放术式.结石平均长径18 mm,平均手术时间131±16min,失血量30±5 ml,1例术后出现尿漏、于术后第3天停止；无其他手术并发症.两组手术时间、出血量、腹膜后引流管停留时间等无明显差异.单孔腹腔镜组在平均住院时间、术后镇痛药应用天数及美容效果等方面优于传统腹腔镜组.两组患者均获得治愈.结论 单孔腹腔镜输尿管切开取石术是可行、有效的,适用于治疗部份体积较大的输尿管结石病例,其远期效果有待增加病例数进一步评估.

Initial experience of retroperitoneal laparoendoscopic single-site surgery for ureterolithotomy

Objective To evalutate the feasibility and effect of retroperitoneal laparoendoscopic singlesite surgery(LESS)for ureterolithotomy.Methods From June 2010 to April 2011,a total of eight patients with upper ureteral calculi underwent LESS ureterolithotomy by using a homemade single port device.Fifteen patients who underwent traditional retroperitoneal laparoscopic ureterolithotomy by the same surgeon were selected for comparison.The operative time,blood loss,operative complication,post-oper- ative hospital stay,post-operative pain and placement time of retroperitoneal drainage tube were compared.Results All LESS ureterolithotomy procedures were completed successfully.No cases were converted to traditional laparoscopic surgery or open surgery. The average longitudinal diameter of the calculous was 18 mm,the mean operative time was 131±16 min,mean estimated blood loss was 30±5 ml.One case had urine leakage in the first three days after the operation.No other operative complications happened.The operative time,blood loss,complications and placement time of retroperitoneal drainage tube were similar between the two groups. However,the average hospital stay,days of pain-killer applied,and the cosmetic result of the LESS group were better than that in the traditional laparoscopic group.All patients in both groups were cured with a mean follow-up time of seven months.Conclusions Laparoendoscopic single-site laparoendoscopic surgery for ureterolithotomy is feasible and effective,it may be applied in bigger ureteral calculi in selective patients.Further studies were needed to evaluate its longterm effects.