后腹腔镜输尿管切开取石治疗嵌顿性输尿管下段结石伴感染的临床体会

目的探讨后腹腔镜输尿管切开取石治疗嵌顿性输尿管下段结石伴有感染的安全性、有效性及实用性。方法回顾性分析2017年6月至2019年6月我科收治的6例诊断为嵌顿性输尿管下段结石伴有感染的病例资料,其中4例术前行体外冲击波碎石术(ESWL)治疗失败,2例术前尿培养阳性且伴有发热,尿常规WBC均为++~+++,均采用后腹腔镜下输尿管下段结石切开取石术,记录其手术时间、术后肠功能恢复时间、总住院天数及相关并发症。结果6例患者行经腹膜后腹腔镜下输尿管下段结石切开取石术均获得成功,无一例中转经腹入路腹腔镜下输尿管切开取石或开放手术。手术时间为55~100 min(平均82.5 min);术后肠功能恢复时间为1~2 d(平均1.7 d),总住院时间7~13 d(平均8.5 d)。其中1例术后拔除尿管后出现腰痛、发热,考虑为前列腺增生、尿潴留、尿液返流所致尿外渗,予保留导尿后症状消失。随访时间3~12个月,均无结石复发、输尿管狭窄等严重并发症。结论经后腹腔入路腹腔镜输尿管下段切开取石术安全可行,创伤小、恢复快,尤其适用于伴感染的输尿管结石患者,值得临床推广,但对术者的腹膜后解剖及腔镜技术提出了更高要求。

Clinical experiences of retroperitoneal laparoscopic ureterolithotomy for the treatment of inferior ureteral calculi with infection

Objective To investigate the safety,efficacy and practicability of retroperitoneal laparoscopic ureterolithotomy in the treatment of inferior ureteral calculi with infection.Methods Retrospective analysis of 6 patients diagnosed with incarcerated ureteral calculi with infection in our department from June 2017 to June 2019,4 of them failed after ESWL,2 had positive urine culture before surgery and accompanied with fever before operation,the routine WBC of urine was positive(++~+++),The laparoscopic ureteral calculi incision and stone removal were performed.The operation time,postoperative intestinal function recovery time,total hospitalization days and related complication were recorded.Results All the 6 patients were successfully treated with retroperitoneal laparoscopic lithotomy of the lower segment of the ureter,and none of them were converted to laparoscopic uretholithotomy or open surgery through abdominal approach.The operation time was 55-100(mean 82.5)min;the postoperative intestinal function recovery time was 1-2 days(average 1.7 days),and the total hospital stay was 7-13(mean 8.5)days.One case had low back pain and fever after removal of the urethral catheter.Considering the extravasation of benign prostatic hyperplasia,urinary retention,and urinary reflux,the symptoms disappeared after the catheterization was preserved.During the follow-up period from three to twelve months,there were no serious complications such as recurrence of stones and ureteral stricture.Conclusions Laparoscopic lower uretholithotomy via retroabdominal approach is safe and feasible,with less trauma and faster recovery.It is especially suitable for patients with ureter calculi with infection.It is worth popularizing in clinic,but it puts forward higher requirements for retroperitoneal anatomy and endoscopic surgery.