后腹腔镜治疗上尿路结石的再探讨

目的探讨后腹腔镜治疗上尿路结石的临床应用价值、技术改良及相关问题的处理。方法回顾性分析31例后腹腔镜上尿路切开取石的临床资料。男18例，女13例。平均年龄48岁。肾盂输尿管交界处结石7例，输尿管上段合并。肾盂、肾盏多发结石7例，输尿管结石17例。其中，合并有输尿管炎症、狭窄、息肉等病变6例。结果31例患者均取石成功，手术时间60—150min，平均90min；术中出血量20～50ml，平均30ml;术后有2例漏尿3d；患者于4．5d拔除后腹膜腔引流管；术后平均住院时间7．10d。随访3～12个月，患者肾输尿管积水均明显好转或消失，无结石复发，无肾盂、输尿管缝合或吻合处狭窄。结论后腹腔镜治疗上尿路结石是可行的，对上尿路其他相关病变可一并处理。同时，结合纤维胆道镜的应用可延伸后腹腔镜在泌尿系结石治疗中的适应证。

Re-evaluation of the therapy for upper urinary tract calculi with retroperitoneal laparoscopic ureterolithotomy

Objective To evaluate the clinical application, improvement of technique and treatment of correlated problem in the therapy for upper urinary tract calculi with retroperitoneal laparoscopic ureterolithotomy. Methods Retrospective analysis was taken to analyze the clinical data of patients （n=31, male for 18,female for 13,mean age 48 years）who were treated with retroperitoneal laparoscopic ureterolithotomy. The junction of renal pelvis and ureter occurred in 7 cases, upper ureteral calcul with multiple renal calculi in 7 cases,ureteral calculi in 17 cases. Of the total,6 cases companied with inflammation, stenosis and polypi in the ureter. Results Thirty one cases of retroperitoneal laparoscopic ureterofithotomy were successfmly done.The operation time was 90 rain （range： 60-150 min）. Intraoperative blood loss was 20 to 50 ml （mean, 30 ml）. Two patients had urine leakage for 3 days. Retroperitoneal drainage tube was removed 4 to 5 days after the operation. The postoperative hospital stay ranged from 7 to 10 days.All patients achieved a 3- to 12-month follow-up, hydronephrosis was lightened or disappeared, recurrent calculi and ureterostenosis was not found. Conclusion Retroperitoneal laparoscopic ureterolithotomy is supposed to be a feasible technique in upper urinary tract calculi treatment, it can deal with the correlated trouble of upper urinary tract simultaneously.And the application of retroperitoneal laparoscopic ureterolithotomy com- bined with choledochofiberscope will extend the indication in the treatment of urinary tract calculi.