后腹腔镜下肾窦内肾盂切开取石术:附13例报告

目的 探讨后腹腔镜下肾窦内肾盂切开取石治疗肾鹿角状及多发性结石的疗效.方法 肾多发及鹿角状结石患者13 例,其中男8 例,女5 例.平均年龄41 岁.结石直经1.8耀2.7 cm.常规采用3 个Trocar,于腹膜后间隙建立气腹,紧贴肾盂外膜向肾窦内分离,暴露出肾盏漏斗部,切开取石,输尿管内置入双J 管,4-0 可吸收线缝合肾盂切口,冲洗、放置引流管.术后5耀6 d 拔出引流管.4 周左右拔出双J 管.结果 13 例手术均获成功,平均手术时间96 min.术后平均住院7 d.随访3耀18 个月,腹部平片(KUB)及静脉肾盂造影(IVU)示无结石残留,肾盂出口输尿管无狭窄,双肾输尿管均显影.结论 腹腔镜下肾窦内肾盂切开取石术是治疗肾结石可选择的一种微创手术,该术式能同期处理上尿路合并症,可部分替代开放性手术.

Retroperitoneal laparoscopic pyelolithotomy:report of 13 cases

Objective To evaluate the clinical efficacy and safety of retroperitoneal laparoscopic pyelolithotomy in the treatment of intrarenal pelvic staghorn calculus or multiple renal calculus.Methods Thirteen patients(8 males and 5 females) with average age of 41 years were treated.The diameters of calculi were from 1.8 cm to 2.7 cm.Three trocars were used in this procedure as routine.The renal sinus was exposed by separating the pelvis from outside to inside until reaching the infundibulum of the renal calyx.Then the renal calyx was cut and the calculus was dislodged.Double J stent was inserted into the ureter and the incision of pelvis was closed with 4-0 absorbable suture.The drainage tube was pulled out 5-6 day postoperatively according to the drainage quantity.Double J stent was pulled out 4 weeks after surgery.Results All 13 procedures were successfully completed.The average operation time was 96 min and the average postoperative hospital stay was 7 day.During the 3-18 months follow up,KUB and IVU showed no upper urinary tract stricture and no residual stones.The kidney function was improved in all cases.Conclusions Laparoscopic pyelolithotomy is an alternative minimally invasive approach for renal calculus,by which procedure the upper urinary tract complications can be treated concomitantly,thus it can partially replace open surgery.