后腹腔镜技术治疗输尿管结石(附31例报告)

Clinical significance of retroperitoneal laparoscopy for ureteral calculi

目的探讨后腹腔镜输尿管切开取石治疗输尿管结石的适应证、手术技巧和临床价值。方法回顾分析采用后腹腔镜输尿管切开取石术治疗输尿管结石31例,其中输尿管上段结石22例,中段结石9例。15例术前行体外冲击波碎石术(ESWL)没有效果;2例行输尿管镜取石术失败;14例术前未行其他治疗。结石直径12-25 mm,平均18.5 mm。结果31例患者取石均成功,手术时间50-130 min,平均85 min;术中出血量20-60 mL,平均35 mL。术后无漏尿;患者术后1-2 d拔除后腹膜腔引流管,术后住院3-6 d。随访2-24个月,患者肾、输尿管积水均明显好转,无结石复发和输尿管切开缝合处狭窄。结论后腹腔镜输尿管切开取石术可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,对于较大的输尿管结石可作为首选的治疗方法。

Objective To evaluate the selection of indications, surgical techniques and clinical effects of retroperitoneoscopic ureterolithotomy. Methods The clinical data of 31 cases （23 males and 8 females） of retroperitoneoscopic ureterolithotomy were retrospectively analyzed. Of the 31 cases, 22 had upper ureter stones and 9 middle ureter stones. Retroperitoneoscopic ureterolithotomy was carried out in 17 patients as a salvage procedure after unsuccessful ESWL or ureteroscopy, and in 14 patients as a primary procedure. The stone size ranged from 12 mm to 25 mm（mean 18.5 mm）. Results All the 31 cases underwent retroperitoneoscopic ureterolithotomy successfully. The operative time ranged from 50 to 130 min（mean 85 min） ; the intraoperative blood loss from 20 to 60 mL（mean 35 mL） postoperatively. The retroperitoneal drainage tubes were removed after 1 to 2 days post operation. The postoperative hospital stay was 3 to 6 days. During the follow-up period（2--24 months）, no ureteric stricture or recurrent calculus were found. B ultrasound and IVP examinations showed that hydronephrosis and hydroureterosis were lessened. Conclusion As a salvage procedure for failed ESWL and URL, retroperitoneoscopic ureterolithotomy is safe, reliable and minimally invasive. It can partially replace conventional open surgery, and in selected patients with large chronically impacted upper ureteric stones, it may be considered as the first choice of treatment.