后腹腔镜与经腰背部途径治疗输尿管上段结石的疗效比较

Comparison of surgical outcome between retroperitoneal laparoscopic and lumbar straight incision ureterolithotomy

目的对后腹腔镜和经腰背部途径治疗输尿管上段结石的疗效指标进行比较,探讨两种术式的技术要点。方法收治98例上尿路结石病例,其中42例行后腹腔镜输尿管切开取石术,56例行经腰背部直切口输尿管切开取石术。腹腔镜术式采用气管插管全麻,经腰背部途径采用腰硬联合麻。两组术中均留置双J管。结果98例手术全部成功,两组术中均无需输血。两组在手术时间、术中出血及住院时间有统计学差别,术后复查未见结石残留,随访无并发症发生。结论对输尿管上段结石的治疗,后腹腔镜输尿管切开取石术微创、安全、有效,较经腰背部途径术中出血少、术后恢复快。但它需要较长的手术时间和一定的腹腔镜外科训练。

[Objective] To compare the surgical outcome and evaluate surgical techniques between retropefitoneal laparoscopic and lumbar straight incision ureterolithotomy. [Methods] 98 patients who had upper urinary tract calculi were enrolled in this study. 42 patients underwent retroperitoneal laparoscopic ureterolithotomy and 56 underwent lumbar straight incision ureterolithotomy. Laparoscopic approach was performed under trachea anaesthesia and lumbar straight incision approach were performed under lumbar anesthesia. All patients were treated with double J stents as internal stent and internal drainage. [Results] All the operations were successful and had no blood transfusion. The operative time, blood loss and length of hospital stay were different significantly between two groups. No postoperation calculus remained and no postoperative complications occurred at postoperative visit in both groups. [Conclusions] Retroperitoneal laparoscopic ureterolithotomy is a minimal invasive, safe, effective and bear less blood loss and rapid postoperative rehabilitation compared with the open surgery. However, it requires a long time operation and certain laparoscopic training.