腹腔镜下两种手术路径行输尿管切开取石的临床疗效比较

目的分析比较腹腔镜下经腹与经腹膜后行输尿管切开取石术的疗效。方法对我院2008年2月～2010年9月65例采用腹腔镜手术的输尿管结石患者随机分为经腹腔(31例)和经腹膜后(34例)两组,比较分析两种手术方式的治疗效果。结果 65例患者均成功取石;两组在手术时间、术中出血量、术后留置引流管时间、住院时间、术后7 d结石清除率、术后3个月结石清除率方面差异均无统计学意义(P>0.05),但经腹膜后组疗效相对更好;并发症方面仅经腹组出现1例皮下气肿、经腹膜后组出现2例皮下气肿,未经处理自行吸收,两组均未出现尿漏。结论经腹与经腹膜后腹腔镜下输尿管切开取石术创伤小、并发症少、安全有效,均有很高的结石清除率,腹腔镜手术可作为输尿管结石的首选术式。

Clinical effect of laparoscopic ureterolithotomy through two different surgery paths

Objective To compare the clinical effect of laparoscopic ureterolithotomy through two different surgery paths. Methods In the clinical study, from February 2008 to September 2010,65 patients treated by laparoscopic ureterolithotomy were divided randomly into abdominal cavity group （31 eases）and retroperitoneal group （34 cases）, the clinical effect of two different surgery paths were compared. Results All patients completed the surgery successfully;the outcome of operation time.blood loss.drainage time.hospital stay,stone free rate of 7 d and 3 months after surgery of two groups had no significant difference（P all 〉 0.05） ,but the clinical effect of the retroperitoneal group was comparatively superior to that of abdominal cavity group;the abdominal cavity group had 1 subcutaneous emphysema while the other group had 2 cases,but they were absorbed without treatment, and all patients had no urinary leak. Conclusion Laparoscopic ureterolithotomy through abdomi- nal cavity path and retroperitoneal path are safe, high-performance,low-damage,the rate of adverse reaction is low and the stone free rate is high.Therefore,it is considered as the first choice of ureteral calculus treatment and worth popularizing.