微创手术治疗输尿管上段结石256例报告

Mini-invasive surgery for upper ureteral stones treatment

目的:探讨输尿管上段结石的微创手术治疗方法。方法:回顾性分析输尿管镜、后腹腔镜以及经皮肾镜治疗输尿管上段结石患者256例的临床经验,其中接受输尿管镜取石术176例,后腹腔镜取石术45例,经皮肾镜取石术35例。结果:本组结石长径6～25mm。输尿管镜取石成功率为81.3%,失败原因主要为输尿管扭曲、狭窄或结石下方有息肉梗阻;腹腔镜和经皮肾镜手术均获成功。所有患者术中留置双J管,1～3个月后拔除,无严重并发症发生。结论:微创手术治疗输尿管上段结石安全有效。对于较小结石,可选择输尿管镜取石;若结石体积较大、靠近UPJ、并肾内结石或输尿管镜手术失败,腹腔镜或经皮肾镜可提高手术成功率,并减少术后结石残留。

Objective：To evaluate mini-invasive surgery for upper ureteral stones treatment. Methods：256 cases of upper ureteral stone treated by ureteroscopy, retroperitoneal laparoscopy and percutaneous nephrolithotripsy were reviewed. Results：Since the January of 2004, 153 men and 103 women were treated with the mean age of 40 （range from 19-78） years old. The stone located in right side in106 cases, left cases in 130 cases and bilateral side in 20 cases. The size of the calculi was 6-25 mm. 153 cases had experienced a failed ureteroscopy and 29 cases had ureterotomy history before. All cases had had some extent of hydronephrosis. Among them, ureteroscopy was performed in 176 cases, retroperitoneal laparoscopy in 45 cases and percutaneous nephrolithotripsy in 35 cases. success rate of ureteroscopy was 81.3%. failure resons were ureteral wrench, stricture and obstructed polyp. All retroperitoneal laparoscopy and percutaneous nephrolithotripsy cases were successful. Ureteral stent was inserted in all cases for 1-3 months. No severe complications were found. Conclusions： Mini-invasive surgery for the treatment of upper ureteral stones was safe, less traumatic and effective. Ureteroscopy was suitable for small ure teral stones. For some ureteral stones which were larger, close to UPJ, eompanying with renal stones or failed ureteroseopy history, retroperitoneal laparoscopy and percutaneous nephrolithotripsy could increase the surgery success and stone-free rate.