腹腔镜下输尿管切开取石术18例报告

The experiences of laparoscopic ureterolithotomy(Report of 18 cases)

目的：探讨腹腔镜下输尿管切开取石术的临床意义和初步经验。方法：2004年1月～2005年2月应用三套管技术完成腹腔镜下输尿管切开取石术18例，其中左侧11例，右侧6例，双侧1例。手术经腹腔途径。取石后直接在镜下用改良法放置双J管，缝合输尿管切口和肾周筋膜。结果：手术均取得成功，手术时间60～210min，平均116min；失血20～50ml；术后住院4～7天，平均5．1天。无一例发生尿漏及腹腔感染。随访2～16个月，输尿管无狭窄。肾功能改善。无粘连性肠梗阻发生。结论：腹腔镜输尿管切开取石术创伤轻、痛苦少、恢复快，良好的手术暴露、内引流、可靠的输尿管缝合以及肾周筋膜的缝合可以减少并发症的发生，是治疗输尿管结石有效、可行的微创技术，有推广价值。

Objective：To explore the technique of laparoscopic ureterolithtomy. Methods：From January 2004 to February 2005, 18 cases of ureterolithiasis were treated by laparoscopic ureterolithtomy. Results： All of the cases were underwent laparoscopic ureterolithtomy successfully. The operating time ranged from 60 to 210 minutes （meafl 116 minutes）. The blood loss ranged from 20 to 50 ml. No postoperative urine leakage occurred. During the follow-up period, no ureteric stricture or recurrent calculus had been found, and all patient＇s renal function had been improved. Conclusions：As a minimally invasive technique, laparoscopic ureterolithtomy proved to be safe and effective for the treatment of ureterolithiasis. Transperitoneal approach with good exposure,stitch of ureter incision, reliable intralumen drainage with a double J catheter were helpful to decrease the postoperative complications.