后腹腔镜输尿管切开取石术治疗嵌顿性输尿管上段结石

Retroperitoneoscopic Ureterolithotomy for Incarcerated Upper Ureteral Calculi

目的：探讨后腹腔镜输尿管切开取石术治疗输尿管上段嵌顿性结石的临床效果。方法2006年10月～2013年3月我院应用三套管技术对60例输尿管上段结石行后腹腔镜输尿管切开取石术，取石后镜下置入双J管，3-0可吸收线间断缝合输尿管切口。结果手术均获成功，无中转开腹。手术时间40～120 min，平均60 min；出血量50～150 ml，平均75 ml。结石清除率98．3％（59／60），部分结石上移至肾盂1例。术后住院5～7d，尿漏1例。术后2～4周拔出双J管。31例随访3～12个月，平均4个月，B超、KUB及静脉尿路造影检查均显示输尿管无狭窄及结石复发，轻度肾盂扩张（4例）或无肾积水（27例）。结论后腹腔腹腔镜输尿管切开取石术治疗输尿管上段嵌顿性结石安全、有效，结石清除率高，良好的双J管引流和镜下缝合打结技术是腹腔镜切开取石术成功的关键。

Objective To evaluate the clinical efficacy of retroperitoneal laparoscopic ureterolithotomy for incarcerated upper ureteral calculi. Methods From October 2006 to March 2013, 60 cases of upper ureteral stones were treated in our hospital by using ureterolithotomy under retroperitoneal laparoscopic surgery .After endoscopic stone extraction , a double-J tube placement was conducted and the incision was sutured with 3-0 absorption thread . Results All the operations were successful .The operation time was 40-120 min, with an average of 60 min.The blood loss was 50-150 ml, with an average of 75 ml.The stone clearance rate was 98.3%（59/60）, with calculi moving upwards into the renal pelvis in 1 case.The postoperative hospital stay was 5-7 d.Urinary leakage occurred in 1 case.The double-J tube was pulled out 2-4 weeks after operation.Follow-up reviews for 3-12 months （mean, 4 months） in 31 cases showed no ureteral stricture or stone recurrence under B-ultrasonography , KUB, and intravenous urography . There were 4 cases of mild pyelectasis , and the remaining 27 cases had no uronephrosis . Conclusions The retroperitoneal laparoscopic ureterolithotomy is safe and effective ,with high stone clearance rate .A good double J tube drainage and skilled endoscopic knotting techniques are crucial to a successful surgery .