腹腔镜下中上段输尿管切开取石术

Middle and upper segmental ureterolithotomy with laparoscopy

目的:探讨腹腔镜下中上段输尿管切开取石术的疗效和临床意义。方法:2005年9月～2006年12月收治输尿管中上段结石18例,采用经腹腔途径腹腔镜下施行输尿管中上段切开取石术手术,取石后直接于镜下置入双J管,缝合输尿管切口及肾周筋膜。结果:18例手术均获成功,无一例中转开放手术,手术时间30～93min,平均44min,失血20～50ml,均未输血,术后次日可下床活动,1～2天均肛门排气,1～3天拔除腹腔引流管,5～7天拔导尿管,肉眼血尿3～5天,术后住院时间5～7天,3～4周后膀胱镜下拔除双J管,随访3～15个月,B超显示肾积水明显好转或消失。结论:腹腔镜下中上段输尿管切开取石术疗效好,创伤小、痛苦少、恢复快,更适用于不具备输尿管肾镜设备和技术的基层医院。

The purpose is to discuss the curative effect and clinic meaning of the laparoscopy set when it is used for middle and upper segmental ureterolithotomy. Methods： 18 patients who has upper and middle segmental concretion have been accepted during Sept. 2005 to dec. 2006. There are 14 male and 4 female. The patients＇ age scope is 21--63 and advantage age is 42 years old. There are 10 patients having the stone in the left kidney, 7 in the right and 1 in both sides. The upper and middle segmental ureterolithotomy were operated by lap- aroscopy set through the abdominal cavity. Insert two ＂J＂ tubes when the stone was taken out, then sew up the cut of ureter and perirenal aponeurosis. Results：The 18 operation cases are all successful and no one need open operation. The time for the operation is 30 to 93 mins, the advantage time is 44 mins. The capacity of blood loss is 20 ml to 50 ml and no one need blood transfusion. Patients can walk next day. The anus can exhaust in 1 to 2 days and the celiac drainage-tube can be pulled out in 1 to 3 days. The ureter tube can be pulled out in 5 to 7 days. The phenomenon of macroscopic hematuria will be last for 3 to 5 days. Days in hospital is usual 5 to 7 days after operation. And two ＂J＂ tubes can be pulled out after 3 to 4 weeks under the cystoscope. Hydronephrosis becomes better or recover by Type B ultrasonic examination after 3 to 15 months fixed examination. Conclusions：The character of laparoscopy set used for ureterolithotomy has good curative effect, small cut, little pain and quick recovery. It is more suitable for skeleton hospital which has no ureterorenoscopy set and technioue.