腹腔镜辅助体外输尿管切开取石术21例报告

Laparoscopic-assisted extracorporeal ureterolithotomy:a report of 21 cases

目的：探讨腹腔镜辅助体外输尿管切开取石术治疗输尿管中上段结石的可行性.方法：经腹腔在腹腔镜下游离结石部位输尿管,延长结石体表投影处戳口1～2cm,通过戳口将结石部位输尿管提至腹壁外,行输尿管切开取石术.结果：21例手术均获成功.手术时间为28～65min,平均43min;术中出血量10～40ml,平均25ml;术后住院7～8d,平均7.3d;术中术后无并发症发生.19例随访2～12个月,平均5.5个月,经静脉肾盂造影或B超检查未见积水及结石复发.结论：腹腔镜辅助体外输尿管切开取石术结合了开腹手术与腹腔镜手术的优点,减少了手术创伤,缩短了手术时间,手术难度降低,术后患者康复快,效果满意.

Objective： To explore a new technique of laparoscopic-assisted extracorporeal ureterolithotomy in treatment of upper or middle ureter calculi. Methods：Twenty-one patients with upper or middle ureter calculi transperitioneally underwent laparoscopic dissection of the ureter where the calculi was, and ureterolithotomy was performed extracorporeally through a expanded trocar-incision （extension of 1-2cm）. Results： All the operations were performed successfully. The operating time was 28-65min （mean,43min）, the blood loss was 10 -40 ml（ mean, 25 ml）, and the postoperative hospitalization was 7-8 d （ mean, 7.3 d）. No complications occurred. Follow- up assessment for 2-12 months （mean,5.5months）was available in 19 patients, and intravenous urography（IVU） and B-ultrasound showed no calculi and hydronephrosis recurrence. Conclusions： Laparoscopic-assisted extracroporeai ureteroiithotomy in treatment of upper or middle ureter calculi combined the advantage of open surgery and laparoscopic operation. It has the advantages of minimal invasion, quick recovery, short hospitalization and it can simplify the operative manipulation and shorten the operating time. It was worth being generally applied in the clinical practice.