后腹腔镜技术治疗输尿管结石的临床价值

Clinical significance of retroperitoneal laparoscopy for ureteral calculi

目的 探讨后腹腔镜输尿管切开取石术的适应证选择、手术技巧及临床应用价值。 方法 回顾性分析 15例后腹腔镜输尿管切开取石术的临床资料。男 7例 ,女 8例。平均年龄 4 3岁。输尿管上段结石 10例 ,中段结石 5例。 结果 15例患者取石均成功 ,手术时间 5 0～ 130min ,平均6 5min ,术中出血量 2 0～ 4 0ml,平均 2 5ml。术后有 7例漏尿 1～ 3d ;患者术后 3～ 5d拔除后腹膜腔引流管 ,术后住院 3～ 5d。随访 2～ 12个月 ,患者肾输尿管积水均明显好转 ,无结石复发和输尿管吻合处狭窄。 结论 后腹腔镜输尿管切开取石术作为体外冲击波碎石术 (ESWL)或输尿管镜 (URL)治疗输尿管结石失败的补救措施 ,可部分取代传统的开放性手术。

Objective To evaluate the selection of in di cations, surgical techniques and clinical effects of retroperitoneoscopic ureter olithotomy. Methods The clinical data of 15 cases (7 males and 8 fe males) of retroperitoneoscopic ureterolithotomy were retrospectively analyzed.Of the 15 cases,10 had upper ureter stones and 5,middle ureter stones. Results All the 15 cases underwent retroperitoneoscopic ureterolit hotomy successfully.The operative time ranged from 50 to 130 min (mean,65 min);t he intraoperative blood loss ranged from 20 to 40 ml (mean,25 ml).Postoperativel y,7 cases experienced 1 to 3 days’ leakage of urine.The retroperitoneal drainag e-tubes were removed 3 to 5 days after operation. The postoperative hospital st ay was 3 to 5 days.During the follow-up period (2-12 months),no ureteric stric ture or recurrent calculus was found. B-ultrasound and IVU examinations showed that hydronephrosis and hydroureterosis were lessened. Conclusions As a salvage procedure for failed ESWL and URL,retroperitoneoscopic u reterolithotomy is safe,reliable and minimally invasive.It can partially replace conventional open surgery in part.