后腹腔镜下输尿管切开取石术

目的:探讨后腹腔镜下输尿管切开取石术的技术要点和临床运用的价值.方法:于腹膜后行腹腔镜输尿管切开取石术24例,其中7例为体外震波碎石失败,其余为初次手术.结石直径为8～24 mm,平均为13 mm.术中24例均缝合输尿管切口及留置6F双J管.结果:2例因结石进入肾脏内改为开放手术,1例因腹膜后粘连较重,术中出血多影响术野,改为开放手术,其余21例手术均取得成功;手术时间55～180 min,平均65 min;其中3例术后发生漏尿,其余术后3～7天拔出腹膜后引流管,术后住院时间为5-9天,随访2-25个月,无严重并发症出现.结论:后腹腔镜下输尿管切开取石术是安全有效的微创手术方式,主要适用较大的结石,可代替传统的开放手术.

Retroperitoneoscopic ureterolithotomy in 24 cases

Objective：To study the technique highlight and clinical value of retroperitoneal laparoscopic ureterolithotomy.Methods：24 cases of ureterolithiasis were treated with retroperitoneal laparoscopic ureterolithotomy.ESWL was failed in 7 of them.The mean size of calculi was 1.3 cm（rangeing 0.8～2.4 cm）.The ureter incisions were sewed up,and the 6F double J tube was placed in all patients.Results：The operations were successful in all of 21 cases.Three cases turned to open operation,because the stone entering the kidney in two cases,and serious adherence in the retroperitoneum in one case.The mean operative time was 65 min（rangeing 55～180 min）.Three cases experienced urinary leakage.The retroperitoneal drainage tube was pulled out after 3～5 d.The post operative hospital stay was 5～9 d.During the follow-up of 2～25 months,no serious complication was found.Conclusion：Retroperitoneal laparoscopic ureterolithotomy is safe,less traumatic and effective,especially for major ureteral stone,and may substitute for the open surgery.